Patient and Family Outcomes of Psychological Interventions in Integrated Pediatric Primary Care

To assess patient and family outcomes of psychological interventions provided by behavioral health clinicians (BHCs) integrated into community-based pediatric primary care practices. Little is known about the feasibility, acceptability, and effectiveness of this treatment strategy in real-world settings.

The sample comprised 5487 patients in ∼80 practices who received psychological interventions from ∼100 integrated BHCs over 2 years. Patients of all ages identified by universal screening or verbal patient/family report as having a developmental or behavioral health (BH) problem of any kind were eligible for intervention. Post-intervention patient clinical improvement was assessed using a clinician-completed standardized clinical global impressions scale. Family satisfaction was assessed using a family-completed standardized patient experience survey.

Patients receiving intervention were predominantly >age 7 and had BH problems (predominantly stress-related, anxiety, depressive, attention, or behavior) that were predominantly mild-moderate in severity. The mean number of intervention visits was 5.6 (range: 3-41; mode: 3). Post-intervention, 72.9% of patients with >3 intervention visits were improved and 28.9% were much or very much improved. After adjusting for potential moderators, lesser odds of improvement were significantly associated with age <7 or 12 to 15 years; symptomatic illness at initial presentation; a disorder other than anxiety; SSRI medication; complex chronic medical disease; and only 3 BHC visits. Overall, 79.3% of families responding to a survey were highly likely to recommend the services to family/friends.

The findings suggest that psychological interventions delivered in the context of integrated BH in a community-based pediatric primary care setting were feasible, valued, and effective.