Results from a Pediatric Collaborative Care Program

Background/Significance

The prevalence of mental health conditions in children and adolescents in the U.S. is approximately 15% (Whitney 2019). However, nearly 50% of these children do not receive treatment (Whitney 2019), with lower treatment rates among people of color (Algeria 2010). Limited access to psychiatric clinicians is the main barrier to care (McBain 2019).

Collaborative care can improve access to mental health treatment and has an emerging evidence base for children and adolescents (AACAP 2023). There are few studies describing real-world applications of the collaborative care model in pediatric populations. Here, we present descriptive data from the collaborative care program at our urban, academic hospital, with a particular focus on the utilization and results for non-White patients.

Methods

This study was IRB approved. Pediatric patients seen in Indiana University’s collaborative care program between July 2019 and December 2021 were tracked using a clinical registry. Demographic data, presenting problem(s), and symptom scales (PHQ-9, GAD, PSC) were recorded as part of routine clinical care. Treatment response was defined as a 50% reduction in symptom scale score.

Results

Three hundred and nineteen pediatric patients were seen in our collaborative care program, for a total of 1756 visits. The average age was 11 years (range 3-18 years), and the average length of time in the program was 17 weeks. One hundred and fifty-eight patients (49.5%) were people of color (33.3% Black/African American, 9.9% Latinx, 2.6% Asian). The main presenting problems were behavioral concerns (n=119), anxiety (n=65), and depression (n=63). Other presenting concerns included ADHD, adjustment disorder, grief, and autism spectrum disorder. Preliminary results indicate that 32% of patients responded to treatment.

Discussion

There are few studies describing real-world pediatric collaborative care programs. Here, we describe the patients seen, conditions treated, and outcomes observed in our collaborative care program. Preliminary results showed improvement in symptom scores across presenting problems, indicating that this model may be effective for a variety of conditions, even outside of research settings.

Conclusion/Implications

Collaborative care can improve access to effective mental health care for pediatric patients. Our clinic served Latinx, Black/African American, and Asian patient populations that were representative of the demographics of the metropolitan area. Further study is necessary to determine if collaborative care increases access to these underserved groups.

References

1. Whitney DG, Peterson MD. US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children. JAMA Pediatr. 2019 Apr 1;173(4):389–91.
   
2. Alegria M, Vallas M, Pumariega AJ. Racial and Ethnic Disparities in Pediatric Mental Health. Child Adolesc Psychiatr Clin N Am. 2010 Oct 1;19(4):759–74.
   
3. McBain RK, Kofner A, Stein BD, Cantor JH, Vogt WB, Yu H. Growth and Distribution of Child Psychiatrists in the United States: 2007–2016. Pediatrics. 2019 Dec 1;144(6):e20191576.
   
4. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry. 2023 Feb;62(2):91–119.