Safety-net Leadership Perspectives on Collaborative Care for Children With Developmental Disabilities

Area of Science:

• Implementation Science
• Pediatric Healthcare
• Developmental Disabilities
• Collaborative Care Models

Background:

• Safety-net primary care settings serve vulnerable populations.
• Children with developmental disabilities (DD) often have complex care needs.
• Existing integrated behavioral health programs may not adequately address DD needs.

Purpose of the Study:

• To identify barriers and facilitators for designing and implementing collaborative care (CC) for children with DD.
• To understand the perspectives of safety-net primary care leaders on CC implementation.
• To inform strategies for improving care delivery for children with DD in primary care.

Main Methods:

• Qualitative study using semi-structured interviews with 16 safety-net primary care leaders across 9 organizations.
• Data collection guided by the Consolidated Framework for Implementation Research (CFIR).
• Analysis using the Rapid Assessment Process with member checking for validation.

Main Results:

• Leaders recognized a clinical need for CC for children with DD, but current programs were insufficient.
• Key barriers included space and cost (inner setting) and restrictive Medicaid reimbursement policies (outer setting).
• Facilitators included perceived clinical need (inner setting) and alternative financing mechanisms (outer setting).

Conclusions:

• Safety-net leaders acknowledge the need for specialized CC models for children with DD.
• Implementation success hinges on overcoming identified space, financing, and policy-related barriers.
• Targeted implementation strategies are necessary to facilitate CC for this population.