There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration.

The medical home and integrated behavioral health: advancing the policy agenda.

OBJECTIVE: The current study examines the scope of integrated behavioral health services provided by behavioral health clinicians in pediatric primary care. METHODS: A cross-sectional electronic health record review was conducted to characterize integrated behavioral health services including consultation types, recommendations, and medical diagnoses. Services were provided over a 6-year period in an urban, residency-training clinic serving a primarily publicly insured population. RESULTS: Of the 4,440 patients seen by behavioral health clinicians (BHCs), 2,829 (63.7%) were seen during well-child checks to address a wide array of presenting problems. The five consultation types "Healthy Steps (6%), pregnancy-related depression (17.7%), developmental (19.2%), mental health (53.2%), and psychopharmacology (5%)" were characterized by differences in demographics, presenting problems, recommendations, and medical diagnoses. CONCLUSIONS: Pediatric BHCs provide a wide range of services to pediatric populations in the context of integrated behavioral health programs. Implications for workforce capacity development, evaluation of outcomes and impact, and sustainability are discussed.© The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: [email protected]/* */ Language: en

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The Scope of Behavioral Health Integration in a Pediatric Primary Care Setting

This article presents results of a survey investigating parents' needs for parenting services, their access to and preferences for parenting programs. Canadian parents (N = 2,340) completed the International Parenting Survey (Morawska, Heinrichs, & Sanders, 2011) with respect to the youngest of their children who was in the 2-12 year age range. In this community sample, over a quarter of parents reported that they had consulted a professional about their child's behavior in the last year. Fifteen percent of parents had participated in some form of parenting program, although only a quarter of these programs were evidence-based. Parents' top-reported barriers to participating in a parenting program were lack of awareness and felt need, followed by practical barriers such as lack of time and access to child care. Parents expressed interest in a diverse array of delivery modes for parenting programs. Implications for enhancing access to parenting programs are discussed.Keywords: access to services, children, parent preferences, awareness of programs, parenting supportResumeLe present article expose les resultats d'une enquete sur les besoins des parents en matiere de services d'aide parentale ainsi que sur l'acces des parents aux differents programmes d'aide parentale et leurs preferences par rapport a ces derniers. Des parents canadiens (N ^ 2 340) ont repondu a l'Enquete internationale aupres des parents (Morawska, Heinrichs, & Sanders, 2011) au sujet de leur enfant le plus jeune se trouvant dans la plage d'âge de 2 a 12 ans. Dans cet echantillon de la collectivite, plus d'un quart des parents ont declare qu'ils avaient consulte un professionnel au sujet du comportement de leur enfant au cours de la derniere annee. Quinze pour cent des parents ont participe a une forme quelconque de programme d'aide aux parents, bien que seulement un quart de ces programmes etaient fondes sur des preuves. Les principales barri- eres citees par les parents concernant la participation a un pro- gramme d'aide parentale etaient qu'ils n'etaient pas au courant ou qu'ils n'en ressentaient pas le besoin, suivies de barrieres pratiques tels que le manque de temps et d'acces aux services de garderie. Les parents ont exprime de l'interet vis-a-vis une panoplie de modes de prestation de programmes d'aide parentale. Les impli- cations relatives a l'amelioration de l'acces aux programmes d'aide parentale sont abordees.Mots-cles : acces aux services, enfants, preferences parentales, sensibilisation aux programmes, aide parentale.One in five children experiences a mental disorder that disrupts their functioning in multiple domains; untreated, many symptoms persist into adulthood (Merikangas et al., 2010). Mirroring the situation in other countries, only 25% of Canadian children in need receive any services (Waddell, Peters, Hua, McEwan, & Garland, 2007). It is clear Canada has a substantial unmet need for services to address children's emotional and behavioral problems. A large body of psychological research has established that family envi- ronments both contribute to and are affected by children's prob- lems (Grusec, 2011). Children and youth with emotional and behavior problems are more likely to grow up in families charac- terized by parental psychopathology, child rearing practices that contribute to the child's dysfunction, aggression between parents, poor family communication, and high levels of parental stress (Kazdin & De Los Reyes, 2008; Piche, Bergeron & Cyr, 2008). To address these issues, a variety of programs have been designed to support parents in providing a positive environment for their children (Sanders, 2012). In this article we describe results from a survey of Canadian parents about whether they have consulted a professional about their child's behavior, whether they have at- tended a parenting program, the perceived barriers to accessing parenting programs, as well as the perceived usefulness of differ- ent modes of delivery of parenting programs. …

The International Parenting Survey-Canada: Exploring access to parenting services

An intersectional perspective on the intergenerational transmission of trauma and state-perpetrated violence

More than Words: The Emotional Maltreatment of Children

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a "voice" to advocate for their support and care. This article (a) highlights several important policy areas that support the social-emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health.

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Florence Nelson

Papers

Opportunities in public policy to support infant and early childhood mental health: the role of psychologists and policymakers.