Building Independent Mental Health Practice Through Collaborative Care

Pediatricians provide the majority of mental health treatment in the United States yet often feel unprepared to diagnose and manage anxiety and depression. Integrated care models such as collaborative care support provider competence and ability to treat youth mental health problems. These models may result in increased independent management of patients by pediatricians.

We conducted a 4-year retrospective cohort study comparing the trajectory of pediatricians' behaviors (ie, mental health diagnosis, treatment, visit frequency) across 2 practice groups. Group 1 (N=16, 3 practices) participated in an off-site collaborative care program, and Group 2 (N=16, 3 practices) did not participate in the program. Outcomes included proportions of patients with pediatrician-assigned diagnoses, frequency of visits, and pharmacologic prescribing.

Pediatrician participation in the collaborative care program was associated with higher odds of seeing patients at least once per year for anxiety and/or depression (OR = 2.35, 95% CI: 1.34-4.15, adjusted P=.015), seeing patients at least 3 times per year for anxiety and/or depression (OR = 2.98, 95% CI: 1.30-6.84, adjusted P=.039), patients receiving an antidepressant prescription (OR = 6.33, 95% CI: 3.58-11.18, adjusted P<.001), and patients receiving an ADHD medication prescription (OR = 1.31, 95% CI: 1.06-1.61, adjusted P=.04).

Participation in a collaborative care program was associated with increased independent pediatrician diagnosis and management of anxiety and depression beyond the formal consultation pathway.