Young People Benefit From Integrated Behavioral-Medical Care

Marcia Frellick

August 11, 2015

Integrating behavioral healthcare within primary medical care leads to significant advantages in bettering outcomes in child and adolescent behavioral health, researchers have found.

A meta-analysis of randomized clinical trials by Joan Rosenbaum Asarnow, PhD, from the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and colleagues showed that youth who had integrated care had a 66% higher probability of having a better outcome than children or adolescents who received usual care (d = 0.32; 95% confidence interval, 0.21 - 0.44; P < .001).

Results were published online August 10 in JAMA Pediatrics.

Dr Asarnow summarized the need for the study by describing the scope of the problem in the United States: "Estimates for adolescents indicate that roughly 40% of teenagers suffer from mental health or substance use disorders within a year," Dr Asarnow said in an audio interview provided by the journal. "Looking at younger kids, 1 out of 8 are estimated to suffer from mental health disorders during a year. This translates to 16 million children in the United States who suffer from mental health or substance use problems.... Over half of these kids with a documented need for mental health care receive no services."

Large Benefits Over a Lifetime

The authors write, "Effective behavioral health care is particularly critical for pediatric populations, with potentially large benefits over a lifetime. The leading causes of death in children and adolescents include unintentional injuries and suicide, both of which are all-too-frequent outcomes of risky behavior and behavioral health problems (eg, depression and substance use)."

Integrated care in this study referred broadly to a range of diverse models, including colocating the services in the primary care setting or integrating the services using web-based or telephone resources or a team approach to care.

Results were strongest when the care included teams of primary care physicians, nurses, psychologists, psychiatrists, social workers, and others working together to evaluate and provide care. With that care model, the probability of better outcomes rose to 73%.

Among the reasons integration into the primary care setting works is that most kids already see a primary care physician or nurse at least once a year, so the integration brings mental health services to where kids already are. That eliminates the stigma or geographical barriers of having to seek help at a separate clinic, Dr Asarnow said in the interview.

For the current review, the authors searched for relevant studies in PubMed, MEDLINE, PsycINFO, and Cochrane Library databases from 1960 through 2014 and found 31 studies with 35 intervention-control comparisons and 13,129 participants who met the study criteria.

Next Hurdle Is Paying for It

In an accompanying editorial, David J. Kolko, PhD, from the Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center in Pennsylvania, said the study provides exceptional evidence that integration works, but noted that the costs for assessment, training, and office preparation will be equally substantial.

"[S]tudies of alternative approaches for promoting the broader implementation and sustainability of behavioral health services (eg, use individual or group-based incentives, pay for implementation) must be conducted to determine what mechanisms will support this new infrastructure," he writes.

In the meantime, the results add confirmation that recent legislation and emerging incentives within the health system are on target, the authors conclude.

"Given the current transformation in the US health care system and increased incentives for integrated medical-behavioral health care, these data documenting the benefits of integrated care enhance confidence that we are on a course that will yield improvements in the lives of youth and families," the authors write.

Dr Asarnow reports receiving funding from the National Institute of Mental Health, American Foundation for Suicide Prevention, American Psychological Association Committee on Division/American Psychological Association Relations, and Society of Clinical Child & Adolescent Psychology (Division 53 of the American Psychological Association) and consulting on quality improvement interventions for depression and suicidal/self-harm behavior. A coauthor reports receiving funding from the National Institute of Mental Health, the International Obsessive Compulsive Disorder Foundation, and the Society of Clinical Child & Adolescent Psychology. Dr Kolko reports receiving monetary compensation for his work as a trainer in Alternatives for Families: A Cognitive Behavioral Therapy.

JAMA Pediatrics. Published online August 10, 2015. Article full text, Editorial full text


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.