Measuring the Level of Behavioral Health Integration in Pediatric Collaborative Care Models

Background: While the idea of providing team-based care that delivers both physical and mental health care to children has existed for nearly five decades, attention has recently focused on collaborative care models (CCMs) as a cost-effective way to improve behavioral health outcomes. These benefits may arise because CCMs pair primary care physicians with behavioral health clinicians in various practice arrangements that permit greater access to care for patients, as well as comprehensive, coordinated care for treating both physical and mental conditions.  Although a wide range of collaborative care models (CCMs) that integrate physical and behavioral health care have been developed, to date there is no extant comprehensive analysis of the level of integration of CCMs that serve children.  It is especially important to consider the case of CCMs for children because their needs are different than adults.  This study: 1) examined the degree of integration of the pediatric CCMs that are discussed in the research literature, and 2) examined the extent to which telemedicine and health information technology such as video-conferencing is incorporated into CCMs. 

Methods: This study followed systematic review standards established by the Institute of Medicine.  Search criteria were developed by an independent research librarian. These criteria were used to search databases such as PubMed, PSYCINFO to identify relevant articles.  A modified content analysis approach was used to assess the CCMs for level of integration using an established conceptual framework.  Forty articles were identified that described 49 models. 

Results:  Ten programs (20%) showed minimal collaboration without co-location, 24 programs (49%) were co-located, but showed only basic collaboration, 3 programs (6%) showed elements of both of these first two categories, and 12 programs (25%) had attained full integration.  Telemedicine was a feature of 10 CCMs and 4 (40%) of these were rated at minimal collaboration,  4 (40%) were colocated but showed only basic collaboration, 1 program (20%) showed elements of both of these first two categories, and 1 program (10%) had attained full integration. 

Conclusions: The study results suggest that efforts are needed to erase barriers that may impede the development of CCMs with a higher degree of integration, in order to reduce healthcare costs and improve outcomes.  This study found that 70% of CCMs had only minimal or basic collaboration.  These low levels of collaboration will make it difficult to understand whether the expected cost savings might occur.  Efforts to reduce barriers are urgent, if these models are to be adopted and live up to their potential to improve services and reduce expenditures.  In addition, further development of the conceptual framework may be needed to accommodate key differentiators (e.g., degree of co-location, business model) for a given CCM that may not move together across the integration level.   The current rubric did not permit us to assess the impact of telemedicine, especially video-conferencing, and this point illustrates the fact that health information technology-facilitated consultation models do not fit well in the conceptual framework.  The models, though successful, did not always result in working “teams” of clinicians.