International perspective on integrated care models in child and adult mental health.

The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.

Perfiles de funcionamiento comportamental en una población de niños con problemas de aprendizaje / Behavioral profiles operating in a population of children with learning disabilities

En el marco de un programa de intervención para favorecer la escolarización de niños de poblaciones vulnerables desde un punto de vista psicosocial, donde el psiquiatra pediátrico participa activamente en un equipo conformado también por psicólogos, psicomotricistas, fonoaudiólogos y maestros especializados, se mide la asociación entre patología conductual y problemas del aprendizaje. Se destaca la construcción de una escala de funcionamiento escolar, administrada al maestro de clase, aplicada a 4.642 niños, que confirma estadisticamente su unidimensionalidad para medir este atributo, donde los ítems académicos y comportamentales contribuyen a la escolarización y la aplicación de un protocolo de historia clínica médico-psicológica, aplicada a 334 niños seleccionados a través de la escala, que muestran la frecuencia de agrupaciones sintomáticas que deben tomarse en cuenta para que los abordajes terapéuticos sean eficientes.