Collaborative care outcomes for pediatric behavioral health problems: a cluster randomized trial

Area of Science:

• Pediatric primary care
• Behavioral health integration
• Child psychology

Background:

• Behavioral and attention-deficit/hyperactivity disorder (ADHD) problems are prevalent in children.
• Existing care models often face challenges in providing timely and effective interventions.
• Integrated behavioral health care aims to improve access and outcomes within primary care settings.

Purpose of the Study:

• To evaluate the efficacy of Doctor Office Collaborative Care (DOCC) for pediatric behavior problems, ADHD, and anxiety.
• To compare DOCC with enhanced usual care (EUC) in community pediatric practices.

Main Methods:

• Cluster randomized trial involving 8 pediatric practices with 321 children and caregivers.
• DOCC group received care from a dedicated care manager.
• EUC group received psychoeducation and facilitated specialty care referral.
• Data collected at baseline and 6, 12, and 18 months.

Main Results:

• DOCC demonstrated significantly higher treatment initiation (99.4% vs 54.2%) and completion rates (76.6% vs 11.6%).
• Improvements observed in behavior problems, hyperactivity, internalizing problems, and parental stress in the DOCC group.
• Higher rates of remission, goal attainment, treatment response, and consumer satisfaction were noted with DOCC.

Conclusions:

• Collaborative care models like DOCC are feasible and effective in community pediatric settings.
• Integrated behavioral health care services show significant utility for managing child behavioral health issues.
• The study supports the broader adoption of collaborative care for improved pediatric outcomes.