Integration of Behavioral Health Services into Primary Pediatric Care: The behind the scenes story of a pilot study in Southeast, Texas

Behavioral health integration in primary care is identified as an important strategy to achieve early identification and treatment of behavioral health disorders. This paper describes a pilot project designed to test the feasibility and sustainability of integrating behavioral health into pediatric primary care clinics. Five private, fee for service pediatric primary care practices were identified in the greater Houston area to establish behavioral health integration. The practices were supported with establishment of behavioral health integration, specifically with recruitment of the behavioral health provider, training of the clinical and administrative teams, and development of interdisciplinary clinical protocols. Difficulties in implementation included differences between medical and psychological provider’s work cultures, credentialing delays, reimbursement barriers, and behavioral health provider difficulties in meeting productivity targets. Strategies for addressing these issues are discussed

Community Readiness to Align and Better Support Families with Perinatal Substance Use Issues and the Impacts of the Covid-19 Pandemic on Progress

Problem: Drug overdose is the leading cause of maternal death in Texas. More than 60% of children in custody of Texas Child Protective Services (CPS) have substance use listed as a contributing factor in their CPS case, compared to the national rate of 34%. Pregnant and postpartum women and infants are a special population impacted by substance use and require a coordinated response from multiple sectors to ensure optimal outcomes for both the mother and her infant. Purpose: In 2018, needs and readiness assessments were conducted in Houston, Texas, focused on improving care and service coordination for pregnant women with substance use disorder (SUD). The purpose of this paper is to briefly describe the results of the assessments and discuss how the Covid-19 pandemic has impacted implementation of the recommendations. Methods: In late 2018, 59 stakeholders from 5 different sectors were interviewed to assess the current system of care and identify recommendations they felt would improve outcomes for pregnant women with SUD. These interviews were followed by 5 collaborative meetings with stakeholders to finalize the recommendations, and a readiness assessment (n=25) to determine the feasibility of implementing the recommendations. The goals of this survey were to determine which of these recommendations were most important, had organizational support for implementation, and would result in improvements within a year of being implemented. Interviews were conducted again in 2020 (n=9) to describe the progress that had been made on the recommendations and assess the impact the Covid-19 pandemic has had on implementing programs and initiatives that support peripartum women with SUDs. Results/Discussion: The stakeholder interviews revealed substantial cross-sector misunderstanding about each sector’s roles and responsibilities. Further, several barriers to coordination were identified. Interviews and collaborative meetings led to the development of 25 recommendations that would improve cross-sector collaboration. There were 25 completed responses to the readiness survey focused on implementing these recommendations. Of the recommendations, 9 had above-average ratings on importance and had ratings indicating substantial short-term impact for pregnant women. Six additional recommendations had above-average ratings on importance, but it was determined that their benefits take longer to be seen. Progress made towards 8 of the recommendations and how the Covid-19 pandemic has impacted this progress are described. Implications: The Covid-19 pandemic has created both opportunities and barriers to progress in the treatment and care of pregnant women with SUD. This analysis identifies resulting changes that must be considered for future planning and intervention implementation

Prenatal depression screening with postpartum follow-up in an integrated healthcare system identifies risks for positive screens and persistent depressive symptoms

Background: Untreated peripartum depression is associated with adverse neonatal and maternal outcomes. The goal of this study was to identify risks for prenatal depression and persistent symptomatology after delivery. Methods: Pregnancies with an Edinburgh Postnatal Depression Scale (EPDS) screening completed at both obstetrics and pediatrics between November 2016 and October 2019 were analyzed (n = 3240). Descriptive and inferential statistical methods were conducted. Results: Black women were more likely to screen positive prenatally (OR 2.42, p<0.001). Single women had more thoughts of self-harm (OR=2.42, p<0.05). Over a third of women screened positive during pregnancy and postpartum. These ‘persistent positives’ were more likely to have higher prenatal EPDS scores (p = 0.02) compared to positive screens that appeared to resolve postpartum. Conclusions: For Black women and those with thoughts of self-harm or high EPDS scores prenatally, there needs to be more timely treatment and/or increased referral to psychiatric services by primary care

Building a Real-World Evidence Base for Improving Child and Family Outcomes

Early childhood, including the infant and toddler years, is a critical developmental period providing the foundation for lifelong relationships, skills, behaviors, and health outcomes. The importance of the adult-child relationships during this period is well established. There are a number of research-based interventions promoting responsive and supportive relationships at home as well as in early childcare programs. However, there are very few rigorously studied interventions that use aligned and/or integrated models supporting coordinated and consistent experiences across the home and early education environments. Additionally, there is a need for implementation evidence in typical home and classroom settings where young children spend much of their time. As part of a federally funded Early Head Start-University Partnership initiative, four research teams from across the U.S. were funded to contribute to the evidence-base regarding how Early Head Start and other early education programs can promote child development by supporting both parenting and center-based care. In this paper, we describe the many contextual, practical, and empirical realities and challenges encountered by the research teams and offer a conceptualization for how research-practice partnerships can provide an avenue for building “real world” evidence in these contexts