Lost in Translation: Identifying Behavioral Health Disparities in Pediatric Primary Care.

Although care within a medical home increases parental satisfaction with health care services and improves health care utilization, significant racial/ethnic and language disparities persist in health care settings. Integrated, team-based approaches can decrease health disparities. The current study examines medical records of 2,353 youth who received a behavioral health consultation in an urban, residency training pediatric primary care clinic. A three-phase, mixed-method approach was used to examine whether differences in clinician-identified presenting concerns and recommendations were present across English-, Spanish-, and Other-language-speaking families. Findings reveal disparities among language groups in presenting concerns and referral to behavioral health services. Factors in medical record documentation also differed across language groups and by provider type. Recommendations for further research, identification, and assessment of psychosocial concerns for families with limited English proficiency (LEP) and development of evidence-based approaches for families with LEP in primary care are discussed.

Four innovations: A robust integrated behavioral health program in pediatric primary care.

The increase in behavioral health problems presenting in pediatric primary care (PPC) has led to a greater focus on the prevention and treatment of mental health concerns. As a result, care has shifted from colocation to integrated PPC models. However, the literature provides limited guidance on the development and implementation of integrated PPC models that aim to transform both PPC and the larger health care system. We developed an integrated behavioral health (IBH) approach modeled with fidelity to the Integrated Practice Assessment Tool to fully integrate behavioral health into PPC. Over the 4 years since the application of our model, we have been successful in the development of an integration process and model for practice transformation of an urban PPC center and the spread and scale of IBH services to 2 additional clinics. Four elements combine to make our integrated behavioral health program novel: (a) clear mission and vision, (b) provision of universal prevention services, (c) continuous quality improvement, and (d) emphasis on practice and systems transformation. Trends in practice and scholarly inquiry indicate the need for robust pediatric IBH models, with a clear mission and vision; articulation of how research informs the development and implementation of the model; and infrastructure to meaningfully examine the model's impact. Cognizant of these needs, Cincinnati Children's Hospital Medical Center developed an IBH program. We provide key learnings for IBH program development, PPC transformation, and innovative systems redesign. We describe these elements and make recommendations for future research and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effective Implementation of Culturally Appropriate Tools in Addressing Overweight and Obesity in an Urban Underserved Early Childhood Population in Pediatric Primary Care.

Overweight and obese children are at an increased risk of remaining obese. The American Academy of Pediatrics recommends addressing healthy habits at well-child checks, but this poses challenges, especially in low-income populations. A clinical innovation project was designed to adapt recommendations in a busy urban clinic and consisted of motivational interviewing, culturally tailored tools, and standardizing documentation. A quasi-experimental design examined innovation outcomes. Of 137 overweight and obese children aged 24 to 66 months, providers' documentation of weight during well-child check visits improved post-innovation ( P < .01), as did development of healthy habits goals ( P < .001). Families were more likely to return for visits post-innovation ( P = .01). A logistic regression analysis showed that adding body mass index to the problem list and establishing a specific follow-up timeframe most predicted follow-up visits to assess progress ( P < .001). Comprehensive innovations consisting of motivational interviewing, implementation of culturally tailored tools, and standardized documentation can enhance engagement in an urban clinic setting.