title: Collaborative care outcomes for pediatric behavioral health problems: a cluster randomized trial.
abstract: OBJECTIVE
  To assess the efficacy of collaborative care for behavior problems, attention-deficit/hyperactivity disorder (ADHD), and anxiety in pediatric primary care (Doctor Office Collaborative Care; DOCC).
  
  
  METHODS
  Children and their caregivers participated from 8 pediatric practices that were cluster randomized to DOCC (n = 160) or enhanced usual care (EUC; n = 161). In DOCC, a care manager delivered a personalized, evidence-based intervention. EUC patients received psychoeducation and a facilitated specialty care referral. Care processes measures were collected after the 6-month intervention period. Family outcome measures included the Vanderbilt ADHD Diagnostic Parent Rating Scale, Parenting Stress Index-Short Form, Individualized Goal Attainment Ratings, and Clinical Global Impression-Improvement Scale. Most measures were collected at baseline, and 6-, 12-, and 18-month assessments. Provider outcome measures examined perceived treatment change, efficacy, and obstacles, and practice climate.
  
  
  RESULTS
  DOCC (versus EUC) was associated with higher rates of treatment initiation (99.4% vs 54.2%; P < .001) and completion (76.6% vs 11.6%, P < .001), improvement in behavior problems, hyperactivity, and internalizing problems (P < .05 to .01), and parental stress (P < .05-.001), remission in behavior and internalizing problems (P < .01, .05), goal improvement (P < .05 to .001), treatment response (P < .05), and consumer satisfaction (P < .05). DOCC pediatricians reported greater perceived practice change, efficacy, and skill use to treat ADHD (P < .05 to .01).
  
  
  CONCLUSIONS
  Implementing a collaborative care intervention for behavior problems in community pediatric practices is feasible and broadly effective, supporting the utility of integrated behavioral health care services.
authors.affiliation: Departments of Psychiatry.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kolko
authors.forename: John
authors.initials: J
authors.lastname: Campo
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hart
authors.forename: Dara
authors.initials: D
authors.lastname: Sakolsky
authors.forename: Stephen
authors.initials: S
authors.lastname: Wisniewski
mesh_terms: D001007:Anxiety / Q000628:therapy*; D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D002653:Child Behavior Disorders / Q000628:therapy*; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team
keywords: clinical trials; collaborative care; evidence-based practice; integrated behavioral health services; pediatric behavioral health problems