title: Doctor-office collaborative care for pediatric behavioral problems: a preliminary clinical trial.
abstract: OBJECTIVE
  To evaluate the feasibility and clinical benefits of an integrated mental health intervention (doctor-office collaborative care [DOCC]) vs enhanced usual care (EUC) for children with behavioral problems.
  
  
  METHODS
  Cases were assigned to DOCC and EUC using a 2:1 randomization schedule that resulted in 55 DOCC and 23 EUC cases.
  
  
  METHODS
  Preassessment was conducted in 4 pediatric primary care practices. Postassessment was conducted in the pediatric or research office. Doctor-office collaborative care was provided in the practice; EUC was initiated in the office but involved a facilitated referral to a local mental health specialist.
  
  
  METHODS
  Of 125 referrals (age range, 5-12 years), 78 children participated.
  
  
  METHODS
  Children and their parents were assigned to receive DOCC or EUC.
  
  
  METHODS
  Preassessment diagnostic status was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-aged Children. Preassessment and 6-month postassessment ratings of behavioral and emotional problems were collected from parents using the Vanderbilt Attention-Deficit/Hyperactivity Disorder Diagnostic Parent Rating Scale, as well as individualized goal achievement ratings forms. At discharge, care managers and a diagnostic evaluator completed the Clinical Global Impression Scale, and pediatricians and parents completed satisfaction and study feedback measures.
  
  
  RESULTS
  Group comparisons found significant improvements for DOCC over EUC in service use and completion, behavioral and emotional problems, individualized behavioral goals, and overall clinical response. Pediatricians and parents were highly satisfied with DOCC.
  
  
  CONCLUSIONS
  The feasibility and clinical benefits of DOCC for behavioral problems support the integration of collaborative mental health services for common mental disorders in primary care.
authors: Special Services Unit, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. kolkodj@upmc.edu
authors: David J
authors: DJ
authors: Kolko
authors: John V
authors: JV
authors: Campo
authors: Amy M
authors: AM
authors: Kilbourne
authors: Kelly
authors: K
authors: Kelleher
mesh_terms: D002648:Child; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy; D003299:Cooperative Behavior; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D011320:Primary Health Care