Parents' Preferences for Primary Care-Based Behavioral Services and the COVID-19 Pandemic: A Mixed Method Study.

OBJECTIVE: This study examined how family factors impacted parents' attitudes toward integrated behavioral health (IBH) in pediatric primary care during the COVID-19 pandemic. We hypothesized that COVID-19 impact would predict family functioning challenges, and that pre-existing familial contextual factors would predict parents' interest in IBH modalities. METHODS: Parents of children ages 1.5-5 years (N = 301) from five primary care clinics completed a survey with measures assessing familial contextual factors (income, race and ethnicity, and parents' childhood adversity), COVID-19 impact on family relationships and wellbeing, family functioning (child behavior, parenting self-efficacy, and parent psychological functioning), and parents' preferences for behavioral support in primary care. A subsample of parents (n = 23) completed qualitative interviews to provide deeper insights into quantitative relationships. RESULTS: Higher COVID-19 impact was significantly associated with worse parent mental health and child behavior problems, as well as lower interest in IBH virtual support options. Overall, lower SES and racial and/or ethnic minority parents both indicated greater interest in IBH modalities compared to higher SES and White parents, respectively. Qualitative interviews identified how pandemic stressors led to increases in parents' desire for behavioral support from pediatricians, with parents sharing perspectives on the nature of support they desired, including proactive communication from providers and variety and flexibility in the behavioral supports offered. CONCLUSIONS: Findings have important implications for the provision of behavioral supports for families in primary care, underlying the need to increase parents' access to IBH services by proactively providing evidence-based resources and continuing to offer telehealth support.

Exploring pre-implementation perceptions of integrated care in a university setting.

Objective: To examine providers' perceptions of integrated care prior to the merger of a university's student health center and counseling services. Participants: Seventeen providers across student health services (n = 9) and counseling (n = 8) agreed to participate in the qualitative study. Method: Semi-structured individual interviews that focused on the perceived benefits and challenges of the merger were conducted in December 2019. Following the interviews, a thematic analysis was completed. Results: The perceived benefits noted by providers centered on the ability of an interdisciplinary team to improve the coordination of, access to, and quality of care delivered to students. However, more anticipated challenges were reported by providers (e.g., differences in training and care protocols, losing one's autonomy as a provider). Conclusions: This qualitative study provides a more in-depth analysis of providers' perceptions of integrated care prior to implementation in a university setting and may have implications for model adoption.

New Communities, New Relationships: Reflections from Junior Faculty Engaging in Community-Based Research.

Promising community-level approaches to addressing interpersonal violence have increased in popularity over the last few decades. However, the shift towards community-based research has not necessarily extended to all graduate program pedagogies, especially given the range of disciplines from which researchers of interpersonal violence hail. Coupled with the fact that many new doctorates relocate to unfamiliar communities to secure their tenure-track positions, junior faculty may find the task of forming and maintaining rewarding community partnerships to be daunting at best. This article focuses on the process of embarking on community-based research as a new faculty member within a new community. In this article, three tenure-track assistant professors of a psychology department within an urban, Midwestern-based university reflected on their own experiences establishing community-based research collaborations after relocating for their positions. Personal narratives focused on experienced challenges and successes related to building mutually beneficial relationships with community organizations of relevance to addressing interpersonal violence (e.g., victim response services, healthcare providers, school systems) were written. Individual narratives were then compiled and six overarching themes (i.e., establishing initial connections, messaging and marketing one's research to gain buy-in, overcoming misperceptions and distrust, maintaining relationships as an external partner, conducting research with community organizations, balancing community-based research and academic demands) related to challenges and multiple associated strategies and lessons learned were identified. Implications of this article for researchers of interpersonal violence who are building careers in a new community are discussed. Some of these implications include the need for increased mentorship, trainings and resources that are specifically targeted to junior faculty's unique needs, and changes to departmental and college level infrastructures that better support and reward community-based research.

Parents' Preferences for Behavioral Services in Primary Care During the COVID-19 Pandemic.

OBJECTIVE: Pediatric primary care is an ideal setting to provide behavioral health services to young children and their families during the COVID-19 pandemic. However, it is unclear how the pandemic altered parents' priorities and preferences to obtain behavioral services in this setting. METHOD: Between July 2020 and January 2021, 301 parents of young children in 5 pediatric sites across the United States completed survey measures on their preferences for behavioral topics and service delivery methods in primary care. The current sample was compared with a previous sample of parents (n = 396) who completed the same measures in 2018. RESULTS: Child self-calming was the only behavioral topic that was rated as significantly more important in the pandemic cohort in comparison with the prepandemic cohort. The pandemic cohort also reported significantly more interest in using certain media resources (e.g., mobile apps and videos) as a delivery method and less interest in group classes/seminars. After controlling for demographic differences between the samples, there was an increased preference for multimedia resources overall in the pandemic cohort, as well as a decreased preference for usual care. CONCLUSION: Parents generally endorse similar priorities for behavioral topics in primary care during the pandemic as they did before the pandemic. However, there is a clear preference for more remote and media-based services during the pandemic. Pediatric practices may consider augmenting behavioral health services with multimedia resources during and after the COVID-19 pandemic to meet parents' needs.

Examining Patient and Provider Experiences with Integrated Care at a Community Health Clinic.

The purpose of this study was to examine patient and provider experiences of integrated behavioral health care at a Federally Qualified Health Center (FQHC). Using a mixed methodology design, both patients (n = 186) and providers (n = 17) completed a survey regarding satisfaction with care and the extent of integration at the clinic, as well as attended a focus group or interview (n = 11 patients; n = 12 providers) regarding their satisfaction and experiences. Both patients and providers found integration to be acceptable and satisfactory and the integration of services among different health care providers occurred fairly regularly. Themes from the provider and patient interviews/focus groups highlighted both positive aspects of the integration and specific challenges within the clinic. This more nuanced perspective of integration both replicates and extends upon previous research regarding satisfaction with integrated care and emphasizes the complexities and challenges of integration within community health clinics.

COVID-19 distress, negative parenting, and child behavioral problems: The moderating role of parent adverse childhood experiences.

BACKGROUND: Heightened familial stress and distress during the COVID-19 pandemic may lead to increased negative parenting practices, particularly for parents with substantial adverse childhood experiences (ACES). OBJECTIVE: To determine whether families' COVID-19-related distress is associated with young children's emotional/behavioral functioning via negative parenting, and whether these relationships vary based on parents' ACEs. PARTICIPANTS AND SETTING: Participants were 267 parents of children ages 1.5-5 years recruited from five primary care sites across the United States. METHODS: Participants completed internet questionnaires including measures of demographics, parent ACES, negative parenting, parent mental health, and COVID-19 distress. We used regression analyses to test a moderated mediation model in which the relationship between COVID-19 distress and child emotional/behavioral problems is mediated by negative parenting, and both the direct and indirect effects of COVID-19 distress on child emotional/behavioral problems is moderated by parents' ACEs. RESULTS: Negative parenting significantly mediated the relationship between COVID-19 distress and child emotional/behavioral problems (indirect effect ß = 0.07). Parents' ACEs moderated the associations between COVID-19 distress and both negative parenting and child emotional/behavioral problems, such that each relationship was stronger in the context of higher parental ACEs. The model accounted for 42% of the variance in child emotional/behavioral problems. CONCLUSIONS: Findings have implications for managing risk and promoting well-being in young children during periods of significant stress and routine disruption. This study advances understanding of factors influencing negative outcomes in children during the pandemic's acute phase and may have implications for the development of targeted interventions to improve families' adjustment in the future.

System navigation models to facilitate engagement in pediatric behavioral health services: A systematic review.

INTRODUCTION: Despite increased prevalence and identification of pediatric behavioral health concerns, families face many barriers when attempting to access behavioral health services. System navigators, or individuals experienced in navigating the health system, help to engage families in services by helping individuals overcome barriers for accessing care. However, limited research to date has systematically reviewed the implementation and effectiveness of navigation models in pediatric populations. METHOD: We systematically reviewed published studies examining navigation models for pediatric populations (up to age 18) referred to behavioral health services. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for studies that evaluated a navigation model and included service use outcomes. We aggregated data pertaining to characteristics of the study and navigation model, service use outcomes, and implementation outcomes. RESULTS: Eight studies met inclusion criteria. Families who participated in navigation services were more likely to complete diagnostic assessments and received an increased dosage (e.g., time spent, services completed) of behavioral health treatments. There was notable variability across studies in terms of processes involved in the navigation models. DISCUSSION: Findings indicate that system navigation is a promising method for improving service use for pediatric populations referred to behavioral health services. Future research may continue to examine the effectiveness and implementation of the model, to best understand its benefits and what processes may contribute to improved service outcomes. Public Significance Statement: This paper reviews the effectiveness of system navigator models, which are designed to engage children and families in behavioral health services. The interventions reviewed are associated with increased behavioral health service use in children and show promise as a method of overcoming barriers to accessing behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Behavioral Health in Primary Care: Brief Screening and Intervention Strategies for Pediatric Clinicians.

Despite the high prevalence of behavioral health concerns presenting in pediatric primary care and the growing support for integrating behavioral health services into this setting, a majority of primary care providers do not have access to on-site behavioral health specialists. Fortunately, primary care providers can implement some services typically provided by behavioral health clinicians. This article outlines screening, brief intervention, and referral guidelines for prominent behavioral health problems seen in primary care. The evidence-based approaches have the potential to supplement typical management of behavioral health problems in primary care and provide a foundation for future integrated behavioral health practice.

Engagement interventions delivered in primary care to improve off-site pediatric mental health service initiation: A systematic review.

INTRODUCTION: Although primary care clinicians often refer children and families to community-based mental health services, a sizable number of patients do not make it to their 1st appointment. Engagement interventions delivered in primary care that focus on reducing structural and perceptual barriers to accessing care hold promise to improve this referral-to-service gap. To date, no review to characterize and summarize the effectiveness of such engagement interventions has been completed. METHOD: We conducted a systematic review of pediatric mental health service engagement interventions delivered in primary care over the past 20 years using MEDLINE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO. We narratively summarized the literature and conducted quality and risk of bias analyses. RESULTS: Out of 948 records, 10 studies met inclusion criteria and were reviewed. A variety of engagement interventions were evaluated and demonstrated varying levels of effectiveness in improving service initiation, with the most promising approach being primary care mental health integration. Quality and risk of biases analyses demonstrated several methodological weaknesses of the included studies. DISCUSSION: Currently, there is limited evidence for engagement interventions to improve the referral-to-service gap for children and families. More research is needed to develop and evaluate effective mental health engagement interventions, particularly for disadvantaged youth and families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Control strategies and suicidal ideation in older primary care patients with functional limitations.

OBJECTIVES: Failure to adapt to limitations in control may place older adults at risk for suicidal behavior. The present study examined the relation between control strategies, depressive symptoms, and suicidal ideation in older adults with health-related limitations. METHODS: Cross-sectional study of 50 older adult (aged 65-94) primary care patients with health-related limitations. RESULTS: Compensatory primary control strategies characterized by seeking help from others were associated with lower levels of suicidal ideation, independent of depressive symptoms. Selective primary control strategies (e.g., persistence) were also associated with reduced suicidal ideation independent of depressive symptoms, but only when a low level of compensatory primary control strategies was endorsed. Selective secondary control strategies were associated with higher suicidal ideation, whereas compensatory secondary control strategies (e.g., goal disengagement) were unrelated in this sample after controlling for covariates. CONCLUSIONS: Findings demonstrate that primary care patients with functional limitations who are not striving to meet their goals, either through persistence or by seeking help from others, are at elevated risk of suicidal thinking.