Families, Systems, & Health 

Abstract: The evidence for bringing behavioral health services into primary care can be confusing. Studies are quite varied in the types of programs assessed, what impacts are assessed, what kind of therapy is offered, for what populations, and on how broad a scale. By organizing the evidence into categories: whether the program is coordinated, co-located or integrated, whether for a targeted or non-targeted patient population, offering specified or unspecified behavioral health services, in a small scale or extensive implementation, programs can be compared more easily. By noting what sorts of impacts are reportedimproved access to services, clinical outcome, maintained improvement^ improved compliance, patient satisfaction, provider satisfaction, cost effectiveness or medical cost offset-the most comprehensive overall assessment of this important approach to patients' needs can be encouraged.

Abstract: A biopsychosocial framework for assessing and treating families of children in pediatric health care settings is presented. Guided by a social ecological perspective on child health, the Pediatric Psychosocial Preventative Health Model (PPPHM) is a 3-tier model based on a public health orientation. The goal of the PPPHM is to conceptualize how families of acutely and chronically ill children might be provided psychosocial support to match their level of need and risk. The largest group of families, Universal, consists of competent and adaptive families confronting health-related stressors. A smaller group of families, Targeted, is at some elevated risk for ongoing psychosocial difficulties. The smallest group of families, Clinical/Treatment, exhibits more evident symptomatology. Examples of family and systems interventions that integrate care among behavioral health care providers and within multidisciplinary treatment teams, across levels of the PPPHM, are presented and discussed.