What’s known about implementing co-located paediatric integrated care: a scoping review

Abstract

Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. The literature was systematically searched for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. Studies reporting on the following implementation outcomes were included: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. This search identified 34 unique studies, including randomized controlled trials, observational studies, and survey/mixed method approaches. Components facilitating implementation of on-site integrated behavioural healthcare included interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Some studies found differences in service use by demographic factors, and others reported funding challenges affecting sustainability, warranting further study.

Keywords:

• Integrated care
• paediatric
• implementation
• co-location
• utilization
• primary care

Acknowledgements

The authors would like to gratefully acknowledge Sarah Valentine, PhD, for her contribution in the selection and refinement of implementation outcomes for this study, and Lee Robinson, MD, for his contribution to abstract screening and initial discussions about the scope of the manuscript.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The authors alone are responsible for the content and writing of this paper. Dr Spencer is supported by the National Institute of Mental Health (NIMH) [K23MH118478] and the Gordon and Betty Moore Foundation. Dr Platt is supported by the Johns Hopkins University Department of Psychiatry and Behavioral Sciences and was supported by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by Grant Number KL2TR001077 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institute of Health (NIH), and NIH Roadmap for Medical Research. Dr Wissow is supported by the NIMH [R34MH106645] and the Substance Abuse and Mental Health Service Administration (SAMHSA) [U79SM061259].