Integrating mental health services in primary care continuity clinics: a national CORNET study.
OBJECTIVE
To determine whether pediatric continuity clinics integrate mental health (MH) services into care delivery; and to determine whether the level of MH integration is related to access to MH services, types of MH screening performed, self-efficacy, satisfaction with referral sites, and communication with the primary care provider.


METHODS
Pediatric Residency Integrated Survey of Mental Health in Primary Care (PRISM_PC) is a newly designed cross-sectional, Web-based survey of continuity clinic directors participating in a national network of pediatric continuity clinics (CORNET). Definitions of MH models included integrated or nonintegrated MH models or traditional care. The survey included questions regarding access, screening that was performed at sites, comfort with MH management as well as provider satisfaction and communication with referral sites.


RESULTS
Seventy-eight percent (57 of 73) of CORNET site directors responded, representing input from 30% of US pediatric residency continuity programs. Thirty-five percent (n = 20) reported an integrated MH model while 65% (n = 37) reported a nonintegrated MH model. Seventy-nine percent screened for attention-deficit/hyperactivity disorder, 44% for behavioral-emotional issues, and 19% for pediatric depression. No differences were found in terms of screening or tools used on the basis of the level of MH integration. Those with integrated programs were more likely to have access to an on-site psychologist (P = .001) or psychiatrist (P = .006).


CONCLUSIONS
Directors from one-third of training programs surveyed reported some level of MH integration in their primary care teaching clinics. Future studies are needed to compare patient and resident education outcomes between integrated and nonintegrated sites.
Department of Pediatrics, University of Colorado, Denver; Department of Children's Outcome Research, Children's Hospital Colorado, Denver. Electronic address: Maya.bunik@childrenscolorado.org.
Maya
M
Bunik
Ayelet
A
Talmi
Brian
B
Stafford
Brenda
B
Beaty
Allison
A
Kempe
Niramol
N
Dhepyasuwan
Janet R
JR
Serwint
D003153:Community Health Services / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education*; D011320:Primary Health Care / Q000458:organization & administration*
CORNET; continuity experience; integrated health care; mental health care; pediatric residency education