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Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a

David J Kolko1, John V Campo, Kelly Kelleher

  • 1Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. kolkodj@upmc.edu

Journal of Developmental and Behavioral Pediatrics : JDBP
|May 25, 2010
PubMed

Insights

An on-site nurse-led intervention improved access to mental health services for children with behavioral problems. This modular approach showed modest clinical improvements and increased service completion compared to usual care.

Area of Science:

  • Pediatric mental health
  • Primary care interventions
  • Behavioral health services

Background:

  • Access to mental health services for children with behavioral problems in primary care is often limited.
  • Traditional referral pathways can present barriers to timely and effective treatment.
  • Innovative models are needed to integrate mental health care within pediatric settings.

Purpose of the Study:

  • To evaluate the effectiveness of an on-site modular intervention delivered by nurses.
  • To compare this intervention with enhanced usual care for children with behavioral issues.
  • To assess improvements in access to mental health services and clinical outcomes.

Main Methods:

  • 163 children meeting criteria for externalizing behaviors were randomized.
  • Intervention group received on-site, nurse-administered modular treatment.
  • Control group received enhanced usual care with facilitated referral.

Main Results:

  • The on-site intervention group had significantly higher rates of service receipt and completion.
  • Fewer service barriers and greater consumer satisfaction were reported in the intervention group.
  • Modest, but significant, improvements in some clinical outcomes, including remission of behavioral disorders, were observed at 1-year follow-up.

Conclusions:

  • A primary care-based, nurse-delivered psychosocial intervention is feasible and enhances mental health service access.
  • The intervention demonstrated some clinical efficacy for children's behavioral problems.
  • Multifaceted collaborative care models may further enhance clinical outcomes in pediatric practices.
Abstract

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