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This month, Dr. David Kolko, a Professor of Psychiatry, Psychology, Pediatrics, and Clinical and Translational Science at the University of Pittsburgh School of Medicine, spoke at our Department of Psychiatry Grand Rounds. We were excited to learn about his work and efforts to strengthen the link between mental health and primary care. As described below, we found these efforts inspiring because they provided us with a deeper set of insights about how our work could be used to inform prevention efforts. Here’s a recap of what we learned: 

First, what is “integrated primary health care”? 

While there is no single definition or approach, “integrated health care” (or collaborative care) combines both physical and mental health (or behavioral health) services into one care setting in order to improve the overall quality of care. 

Dr. Kolko’s research focuses specifically on integrated pediatric primary health care, which integrates behavioral health services into children’s primary care. For example, during a child’s visit to his/her primary care provider for a routine physical, he/she may also be screened for behavioral health problems, such as depression or anxiety, by a licensed mental health professional. 

Okay, so why is integrating mental health into primary care important?

With the recognition that physical and mental well-being are often inseparable, interest in integrated primary care is growing. 

Between 13 to 20% of children living in the U.S. experience a mental health disorder in any given year. In fact, depression is one of the most common chronic illnesses during adolescence while suicide, which often co-occurs with depression, is one of the leading causes of death among children and teens. And many ongoing health issues – including anxiety and substance use – begin during childhood.

Unfortunately, many children and families do not have easy access to behavioral health care and, frequently, mental health issues go unidentified and untreated. A startling four out of five children ages 6 to 17 with a mental health problem do not receive any help. Luckily, most children in the U.S. do have access to primary care and see their primary care practitioner annually. Thus, pediatric primary care may provide a unique opportunity to make behavioral health services more accessible for kids and also less stigmatizing.

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What is David Kolko doing with this integrated health care idea? 

Dr. Kolko described his treatment research program, Services for Kids in Primary Care (SKIP), which is devoted to promoting the integration of mental health services in primary care and related health care settings for children. He also summarized some of SKIP’s work evaluating integrated care interventions, which have yielded some pretty striking results: 

  • For example, results from clinical trials of SKIP suggest that children and families in the integrated care model were more likely to receive and complete mental health services, reported easier access to this care and higher satisfaction, and had better mental health outcomes as compared to children receiving care as usual. 

  • Moreover, although the overall cost of the integrated care model was higher (since more children received and completed services), the cost per child treated was actually lower than the usual care model, suggesting that the integrated care model made behavioral health services more affordable for families.

Thus, this work suggests that integrated care is feasible and that it can improve access to mental health care during these early stages of life.  

What are the potential long-term benefits of integrated pediatric health care? 

Dr. Kolko’s research points to many benefits of an integrated approach to child health care, such as improved access to behavioral health services and better treatment outcomes that conceivably lower the risk of adult mental illness. The integrated health care model could also reduce the stigma attached to seeking help for mental health issues when it is part of routine care and offered in a local, familiar setting. 

Of course, there are many barriers to implementing this health care model, including cost and finding the right licensed health professionals to fit the mold. Also, behavioral health care assessments are often very time consuming, lasting several hours, making it hard to tack-on to routine visits. 

Why did this work inspire us?

We were especially excited about the concept of integrated pediatric primary care because it aligns with our work on sensitive periods and suggests how our findings on sensitive periods could be translated to a real-world setting. Sensitive periods are stages in development when experiences, both good and bad, are most impactful. Through our research, we are trying to identify when these sensitive periods occur that increase vulnerability to depression. Once these developmental windows are identified, then what? We think such insights could be directly translated into settings like the integrated primary care model. For example, compared to the usual care model, health providers in the integrated primary care model may be better able to identify children and adolescents who are exposed to adversity during sensitive periods and make sure they get preventative mental health care quickly and easily. And with better access to early mental health care, there’s a better chance we can prevent depression before it ever even starts.

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