There is a mental health crisis that appears to be getting even worse in this country for children as well as adults. Previously published articles note the shortage of specialists in behavioral and mental health care for children and teenagers, making it more and more essential for the medical homes for these children to become more engaged in helping provide this support before behavioral and emotional problems get worse for a child and family. But do these programs work and if so, which ones? Brown et al. (10.1542/peds.2018-0611) decided to examine published literature to look at the effectiveness of behavioral health programs integrated into the primary care setting through a systematic review in Pediatrics.
The authors used a thorough methodologic approach to find 44 studies that contained data via clinical trials, quasi-experimental trials, pilot projects, or pre- and post-survey design to look at the efficacy, effectiveness, and scalability of the programs described in the peer-reviewed literature. Unfortunately, rather than solutions that we can implement, the authors found that their review only helped identify gaps that need to be filled before we can ascertain the right model for integrated behavioral health in the primary care setting.
So what do we do with this information? We asked Dr. John Duby, behavioral and developmental specialist, to share with us his thoughts in an accompanying commentary (10.1542/peds.2018-0156). Dr. Duby reminds us of the importance of integrating behavioral services, not just in the office setting, but with community programs and agencies that can provide such services so that the medical home connects the primary care office even better to what is available in a given community or region, thus, creating a collaborative or “medical neighborhood” that we need to integrate with more fully.
He provides a number of suggestions of such community programs, that while not included in the systematic review, may offer promise. He references a report from the United Nations Office on Drugs and Crime that has compiled evidence-based family skills training programs that have the strongest evidence for success based on randomized controlled trials. To find out what those programs are, and to gain some optimism about what the future may hold to help us help children with behavioral and emotional unrest, take a time out and read both the review article and commentary to learn more.