Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a nurse-administered intervention in primary care.
OBJECTIVE
To determine the effectiveness of an on-site modular intervention in improving access to mental health services and outcomes for children with behavioral problems in primary care relative to enhanced usual care. The study includes boys and girls from six primary care offices in metropolitan Pittsburgh, PA.


METHODS
One hundred sixty-three clinically referred children who met a modest clinical cutoff (75th percentile) on the externalizing behavior scale of the Pediatric Symptom Checklist-17 were randomized to a protocol for on-site, nurse-administered intervention or to enhanced usual care. Protocol for on-site, nurse-administered intervention applied treatment modules from an evidence-based specialty mental health treatment for children with disruptive behavior disorders that were adapted for delivery in the primary care setting; enhanced usual care offered diagnostic assessment, recommendations, and facilitated referral to a specialty mental health provider in the community. The main outcome measures such as standardized rating scales, including the Pediatric Symptom Checklist-17, individualized target behavior ratings, treatment termination reports, and diagnostic interviews were collected.


RESULTS
Protocol for on-site, nurse-administered intervention cases were significantly more likely to receive and complete mental health services, reported fewer service barriers and more consumer satisfaction, and showed greater, albeit modest, improvements on just a few clinical outcomes that included remission for categorical behavioral disorders at 1-year follow-up. Both conditions also reported several significant improvements on several clinical outcomes over time.


CONCLUSIONS
A psychosocial intervention for behavior problems that was delivered by nurses in the primary care setting is feasible, improves access to mental health services, and has some clinical efficacy. Options for enhancing clinical outcome include the use of multifaceted collaborative care interventions in the pediatric practice.
Kolko
David J
DJ
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. kolkodj@upmc.edu
Campo
John V
JV
Kelleher
Kelly
K
Cheng
Yu
Y
D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000628:therapy*; D003156:Community Mental Health Services; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D009726:Nurses; D017060:Patient Satisfaction; D010372:Pediatrics / Q000379:methods*; D010414:Pennsylvania; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D012074:Remission Induction; D016896:Treatment Outcome