Collaborative Mental Health Services for Behavior Disorders in Primary Care

Summary

Principal Investigator: David Kolko
Affiliation: University of Pittsburgh
Country: USA
Abstract: DESCRIPTION (provided by applicant): This competing continuation extends our parent study (Effectiveness of Therapy for Behavior Problems in Primary Care;MH63272) by seeking to more efficiently and effectively treat children with a disruptive behavior problem (DBP) in the pediatric primary-care setting. Our enhanced treatment program, Doctor- Office Collaborative Care (DOCC), reflects a care management approach that incorporates the child's pediatrician through integrated in-house services and resources coordinated by a clinical care manager. Physician clusters from six primary care offices will be randomized to either DOCC or Treatment-as-Usual (TAU). Patients of these PCPs will simply receive the intervention condition of their respective PCPs. Background information will be collected to examine group comparability on the same three covariates as used in the original parent study (ADHD, any other comorbid disorder, prior MH treatment). Based on the findings of our parent study and year-long pilot study, several developments are incorporated herein: 1) Adaptation of the chronic care model and participatory management theory to create an evidence-based collaborative care delivery system designed to enhance training, implementation, and sustainability, 2) revised clinical content that includes medication management for ADHD, brief anxiety management, and attention to parental distress/referral, 3) technological advances to facilitate efficient processes of care, monitoring, and communication, and 4) an improved methodology that includes new samples, measures, and settings. Both intervention process (implementation) and outcome (effectiveness) data will be assessed across four timepoints: 1) intake, 2) discharge, 3) 1-year follow-up, and 4) 2-year follow-up. Assessment will include a multi-method (e.g., individualized and standardized rating scales, office medical records, provider reports), multi-informant (child, parent, care manager, pediatrician) approach to evaluate effects on key child behavioral and emotional outcomes (symptom severity, diagnoses), and functional/health status (impairment). We will also explore the impact of DOCC on child services/systems use, parental functioning, and physician beliefs/practices supportive of collaborative care. Analyses will be conducted using Hierarchical Linear Modeling and Analyses of Variance. The ultimate goal for this research is to establish the viability of an integrated mental health service delivery system within the pediatric primary care setting.
Funding Period: 2000-09-30 - 2012-02-29
more information: NIH RePORT

Top Publications

  1. pmc Quantifying diagnostic uncertainty using item response theory: the Posterior Probability of Diagnosis Index
    Oliver Lindhiem
    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
    Psychol Assess 25:456-66. 2013
  2. pmc The integration of behavioral health interventions in children's health care: services, science, and suggestions
    David J Kolko
    a Department of Psychiatry, University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic
    J Clin Child Adolesc Psychol 43:216-28. 2014
  3. pmc Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a nurse-administered intervention in primary care
    David J Kolko
    Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    J Dev Behav Pediatr 31:393-404. 2010
  4. pmc Trajectories of symptom reduction during treatment for behavior problems in pediatric primary-care settings
    Oliver Lindhiem
    Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O Hara St, Pittsburgh, PA 15213, USA
    Adm Policy Ment Health 38:486-94. 2011
  5. pmc Moderators and predictors of clinical outcome in a randomized trial for behavior problems in pediatric primary care
    David J Kolko
    Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 36:753-65. 2011
  6. doi Doctor-office collaborative care for pediatric behavioral problems: a preliminary clinical trial
    David J Kolko
    Special Services Unit, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    Arch Pediatr Adolesc Med 166:224-31. 2012

Scientific Experts

Detail Information

Publications6

  1. pmc Quantifying diagnostic uncertainty using item response theory: the Posterior Probability of Diagnosis Index
    Oliver Lindhiem
    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
    Psychol Assess 25:456-66. 2013
    ..We illustrate the advantages of the PPOD Index in a clinical sample (N = 321) of children and adolescents with oppositional defiant disorder...
  2. pmc The integration of behavioral health interventions in children's health care: services, science, and suggestions
    David J Kolko
    a Department of Psychiatry, University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic
    J Clin Child Adolesc Psychol 43:216-28. 2014
    ..Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare. ..
  3. pmc Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a nurse-administered intervention in primary care
    David J Kolko
    Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    J Dev Behav Pediatr 31:393-404. 2010
    ..The study includes boys and girls from six primary care offices in metropolitan Pittsburgh, PA...
  4. pmc Trajectories of symptom reduction during treatment for behavior problems in pediatric primary-care settings
    Oliver Lindhiem
    Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O Hara St, Pittsburgh, PA 15213, USA
    Adm Policy Ment Health 38:486-94. 2011
    ..24, P < .05). The implications of these findings for enhancing the efficiency and effectiveness of treatment are discussed...
  5. pmc Moderators and predictors of clinical outcome in a randomized trial for behavior problems in pediatric primary care
    David J Kolko
    Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 36:753-65. 2011
    ....
  6. doi Doctor-office collaborative care for pediatric behavioral problems: a preliminary clinical trial
    David J Kolko
    Special Services Unit, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    Arch Pediatr Adolesc Med 166:224-31. 2012
    ..To evaluate the feasibility and clinical benefits of an integrated mental health intervention (doctor-office collaborative care [DOCC]) vs enhanced usual care (EUC) for children with behavioral problems...