Peer‐to‐Peer Family Navigators in Primary Care: Enhancing Child Mental Health Outcomes
Research ObjectiveOnly 1 in 5 US children with a psychiatric or substance use disorder receives treatment. To investigate the impact of pediatric integrated care, including peer‐to‐peer family support, on identification and engagement of children in an urban safety‐net system.Study DesignWe conducte...
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| Veröffentlicht in: | Health services research 2020-08, Vol.55 (S1), p.27-27 |
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| description | Research ObjectiveOnly 1 in 5 US children with a psychiatric or substance use disorder receives treatment. To investigate the impact of pediatric integrated care, including peer‐to‐peer family support, on identification and engagement of children in an urban safety‐net system.Study DesignWe conducted a prospective, non‐randomized trial comparing clinical functioning and health services utilization outcomes between youths receiving CPM and those receiving usual care. Youths were referred by their pediatricians for child psychiatry evaluation. Each youth’s family was given the option to participate in the 12‐month study following evaluation. Follow‐up observations take place at 6 and 12 months following baseline. Study participants received a multi‐disciplinary, integrated care team evaluation, including peer‐to‐peer parents in the primary care clinic. Claims and electronic medical record data provide information on utilization. We used propensity score weights to balance participants on baseline characteristics and estimated multivariate generalized estimating equations with a difference‐in‐differences framework to produce doubly‐robust estimates of relative pre‐post changes for CPM vs. usual care accounting for clustering of observations within participants.Population StudiedIn the highly diverse population served by this urban safety‐net system, barriers such as stigma, language, and geography create access disparities. Study sample = 171 CPM youth and 290 Controls. All were primary care pediatric patients ages 2 to 17. CPM youth mean age = 10 years; 48.54% identify as female. Study sample families earn |
| doi_str_mv | 10.1111/1475-6773.13361 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7440436</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2435547965</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2111-c43f5e2354664b6f1ae778ccfb7e918eb8c6133d7d8acc7a0683d3df996fff6b3</originalsourceid><addsrcrecordid>eNqFUT1PwzAQtRBIlMLMaok5rV07dsKAhKqWIhVa8bGwWI5jN67SpDhJUTd-Ar-RX4JLqkpMeDhbd-89v7sD4BKjHvanjykPA8Y56WFCGD4CnUPmGHQQwjyI8YCegrOqWiKEIhLRDniba-2-P7_q0ofdG47lyuZb-Cg3diHr0lXQFnDu7Eq6LRxKp6_hqMhkoWyxgMPM5il80EUtczjRMq8zOGtqVa50dQ5OjMwrfbG_u-B1PHoZToLp7O5-eDsN1MD7DhQlJtQDElLGaMIMlprzSCmTcB3jSCeRYr6jlKeRVIpLxCKSktTEMTPGsIR0wU2ru26SlU6VN-NkLtatZVFKK_5WCpuJRbkRnFJECfMCV3sBV743uqrFsmxc4T2LASVhSHnMQo_qtyjlyqpy2hx-wEjsNiB28xa7eYvfDXgGaxkfNtfb_-BiMnp-aok_qkWLjA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2435547965</pqid></control><display><type>article</type><title>Peer‐to‐Peer Family Navigators in Primary Care: Enhancing Child Mental Health Outcomes</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Grimes, K. ; Creedon, T. ; Cook, B.</creator><creatorcontrib>Grimes, K. ; Creedon, T. ; Cook, B.</creatorcontrib><description>Research ObjectiveOnly 1 in 5 US children with a psychiatric or substance use disorder receives treatment. To investigate the impact of pediatric integrated care, including peer‐to‐peer family support, on identification and engagement of children in an urban safety‐net system.Study DesignWe conducted a prospective, non‐randomized trial comparing clinical functioning and health services utilization outcomes between youths receiving CPM and those receiving usual care. Youths were referred by their pediatricians for child psychiatry evaluation. Each youth’s family was given the option to participate in the 12‐month study following evaluation. Follow‐up observations take place at 6 and 12 months following baseline. Study participants received a multi‐disciplinary, integrated care team evaluation, including peer‐to‐peer parents in the primary care clinic. Claims and electronic medical record data provide information on utilization. We used propensity score weights to balance participants on baseline characteristics and estimated multivariate generalized estimating equations with a difference‐in‐differences framework to produce doubly‐robust estimates of relative pre‐post changes for CPM vs. usual care accounting for clustering of observations within participants.Population StudiedIn the highly diverse population served by this urban safety‐net system, barriers such as stigma, language, and geography create access disparities. Study sample = 171 CPM youth and 290 Controls. All were primary care pediatric patients ages 2 to 17. CPM youth mean age = 10 years; 48.54% identify as female. Study sample families earn <$35 000 a year; over 50 % speak a primary language other than English. Most frequent Diagnosis is Anxiety (39%) for CPM and Depression (33%) for Controls. Childhood trauma: 64% of CPM youth have 3+ ACEs.Principal FindingsRace/Ethnicity: 60.8% of our sample identify as Latinx, 17.0% as non‐Hispanic white, and 16.4% as non‐Hispanic Black/African American. ED Utilization drops 58% from baseline to 6 mos. for CPM youth, compared with 4% decline for controls (P < 0.026). Outpatient MH utilization triples (P = 0.002) for CPM use and doubles (P < 0.001) for controls, at 6 mos. Clinical functioning is assessed via two separate standardized measures (CGAS and CAFAS) and statistically significant change from baseline to 6 mos. is found on both measures. Self‐Harm/Lethality scale showed an average improvement of 71% from baseline to 6 mos. post. Study retention was 88% at 6 months.ConclusionsEmerging evidence indicates improved child mental healthcare outcomes are possible for youth with access and engagement barriers, through the introduction of integrated parent support and child psychiatry consultation within familiar pediatric settings.Implications for Policy or PracticeThese early findings suggest that the Collaborative Practice Model has the potential to improve child mental healthcare access and engagement rates in populations at‐risk for disparities. If further study supports these findings, the effect of early engagement could lead to reduced time to treatment; this, in turn, has the potential to lessen the morbidity burden of childhood trauma or emerging mental illness. If the CPM approach can even partially offset access disparities and support treatment engagement, there is an opportunity to shift service use from more restrictive settings to home and community‐based care.Primary Funding SourceSAMHSA.</description><identifier>ISSN: 0017-9124</identifier><identifier>EISSN: 1475-6773</identifier><identifier>DOI: 10.1111/1475-6773.13361</identifier><language>eng</language><publisher>Chicago: Blackwell Publishing Ltd</publisher><subject>At risk populations ; Baseline studies ; Child & adolescent mental health ; Child & adolescent psychiatry ; Child psychology ; Children ; Children & youth ; Clinical outcomes ; Electronic medical records ; Geography ; Health care ; Health care access ; Health status ; Information processing ; Integrated delivery systems ; Language ; Lethality ; Mental disorders ; Mental health ; Mental health care ; Minority & ethnic groups ; Morbidity ; Navigators ; Pediatricians ; Pediatrics ; Population studies ; Primary care ; Special Issue Abstract ; Special Issue Abstracts ; Statistical analysis ; Substance abuse treatment ; Substance use ; Trauma</subject><ispartof>Health services research, 2020-08, Vol.55 (S1), p.27-27</ispartof><rights>Health Research and Educational Trust</rights><rights>Copyright © 2020 Health Research and Educational Trust</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440436/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440436/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,1411,27901,27902,30976,45550,45551,53766,53768</link.rule.ids></links><search><creatorcontrib>Grimes, K.</creatorcontrib><creatorcontrib>Creedon, T.</creatorcontrib><creatorcontrib>Cook, B.</creatorcontrib><title>Peer‐to‐Peer Family Navigators in Primary Care: Enhancing Child Mental Health Outcomes</title><title>Health services research</title><description>Research ObjectiveOnly 1 in 5 US children with a psychiatric or substance use disorder receives treatment. To investigate the impact of pediatric integrated care, including peer‐to‐peer family support, on identification and engagement of children in an urban safety‐net system.Study DesignWe conducted a prospective, non‐randomized trial comparing clinical functioning and health services utilization outcomes between youths receiving CPM and those receiving usual care. Youths were referred by their pediatricians for child psychiatry evaluation. Each youth’s family was given the option to participate in the 12‐month study following evaluation. Follow‐up observations take place at 6 and 12 months following baseline. Study participants received a multi‐disciplinary, integrated care team evaluation, including peer‐to‐peer parents in the primary care clinic. Claims and electronic medical record data provide information on utilization. We used propensity score weights to balance participants on baseline characteristics and estimated multivariate generalized estimating equations with a difference‐in‐differences framework to produce doubly‐robust estimates of relative pre‐post changes for CPM vs. usual care accounting for clustering of observations within participants.Population StudiedIn the highly diverse population served by this urban safety‐net system, barriers such as stigma, language, and geography create access disparities. Study sample = 171 CPM youth and 290 Controls. All were primary care pediatric patients ages 2 to 17. CPM youth mean age = 10 years; 48.54% identify as female. Study sample families earn <$35 000 a year; over 50 % speak a primary language other than English. Most frequent Diagnosis is Anxiety (39%) for CPM and Depression (33%) for Controls. Childhood trauma: 64% of CPM youth have 3+ ACEs.Principal FindingsRace/Ethnicity: 60.8% of our sample identify as Latinx, 17.0% as non‐Hispanic white, and 16.4% as non‐Hispanic Black/African American. ED Utilization drops 58% from baseline to 6 mos. for CPM youth, compared with 4% decline for controls (P < 0.026). Outpatient MH utilization triples (P = 0.002) for CPM use and doubles (P < 0.001) for controls, at 6 mos. Clinical functioning is assessed via two separate standardized measures (CGAS and CAFAS) and statistically significant change from baseline to 6 mos. is found on both measures. Self‐Harm/Lethality scale showed an average improvement of 71% from baseline to 6 mos. post. Study retention was 88% at 6 months.ConclusionsEmerging evidence indicates improved child mental healthcare outcomes are possible for youth with access and engagement barriers, through the introduction of integrated parent support and child psychiatry consultation within familiar pediatric settings.Implications for Policy or PracticeThese early findings suggest that the Collaborative Practice Model has the potential to improve child mental healthcare access and engagement rates in populations at‐risk for disparities. If further study supports these findings, the effect of early engagement could lead to reduced time to treatment; this, in turn, has the potential to lessen the morbidity burden of childhood trauma or emerging mental illness. If the CPM approach can even partially offset access disparities and support treatment engagement, there is an opportunity to shift service use from more restrictive settings to home and community‐based care.Primary Funding SourceSAMHSA.</description><subject>At risk populations</subject><subject>Baseline studies</subject><subject>Child & adolescent mental health</subject><subject>Child & adolescent psychiatry</subject><subject>Child psychology</subject><subject>Children</subject><subject>Children & youth</subject><subject>Clinical outcomes</subject><subject>Electronic medical records</subject><subject>Geography</subject><subject>Health care</subject><subject>Health care access</subject><subject>Health status</subject><subject>Information processing</subject><subject>Integrated delivery systems</subject><subject>Language</subject><subject>Lethality</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Mental health care</subject><subject>Minority & ethnic groups</subject><subject>Morbidity</subject><subject>Navigators</subject><subject>Pediatricians</subject><subject>Pediatrics</subject><subject>Population studies</subject><subject>Primary care</subject><subject>Special Issue Abstract</subject><subject>Special Issue Abstracts</subject><subject>Statistical analysis</subject><subject>Substance abuse treatment</subject><subject>Substance use</subject><subject>Trauma</subject><issn>0017-9124</issn><issn>1475-6773</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqFUT1PwzAQtRBIlMLMaok5rV07dsKAhKqWIhVa8bGwWI5jN67SpDhJUTd-Ar-RX4JLqkpMeDhbd-89v7sD4BKjHvanjykPA8Y56WFCGD4CnUPmGHQQwjyI8YCegrOqWiKEIhLRDniba-2-P7_q0ofdG47lyuZb-Cg3diHr0lXQFnDu7Eq6LRxKp6_hqMhkoWyxgMPM5il80EUtczjRMq8zOGtqVa50dQ5OjMwrfbG_u-B1PHoZToLp7O5-eDsN1MD7DhQlJtQDElLGaMIMlprzSCmTcB3jSCeRYr6jlKeRVIpLxCKSktTEMTPGsIR0wU2ru26SlU6VN-NkLtatZVFKK_5WCpuJRbkRnFJECfMCV3sBV743uqrFsmxc4T2LASVhSHnMQo_qtyjlyqpy2hx-wEjsNiB28xa7eYvfDXgGaxkfNtfb_-BiMnp-aok_qkWLjA</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Grimes, K.</creator><creator>Creedon, T.</creator><creator>Cook, B.</creator><general>Blackwell Publishing Ltd</general><general>John Wiley and Sons Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>K9.</scope><scope>5PM</scope></search><sort><creationdate>202008</creationdate><title>Peer‐to‐Peer Family Navigators in Primary Care: Enhancing Child Mental Health Outcomes</title><author>Grimes, K. ; Creedon, T. ; Cook, B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2111-c43f5e2354664b6f1ae778ccfb7e918eb8c6133d7d8acc7a0683d3df996fff6b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>At risk populations</topic><topic>Baseline studies</topic><topic>Child & adolescent mental health</topic><topic>Child & adolescent psychiatry</topic><topic>Child psychology</topic><topic>Children</topic><topic>Children & youth</topic><topic>Clinical outcomes</topic><topic>Electronic medical records</topic><topic>Geography</topic><topic>Health care</topic><topic>Health care access</topic><topic>Health status</topic><topic>Information processing</topic><topic>Integrated delivery systems</topic><topic>Language</topic><topic>Lethality</topic><topic>Mental disorders</topic><topic>Mental health</topic><topic>Mental health care</topic><topic>Minority & ethnic groups</topic><topic>Morbidity</topic><topic>Navigators</topic><topic>Pediatricians</topic><topic>Pediatrics</topic><topic>Population studies</topic><topic>Primary care</topic><topic>Special Issue Abstract</topic><topic>Special Issue Abstracts</topic><topic>Statistical analysis</topic><topic>Substance abuse treatment</topic><topic>Substance use</topic><topic>Trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grimes, K.</creatorcontrib><creatorcontrib>Creedon, T.</creatorcontrib><creatorcontrib>Cook, B.</creatorcontrib><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Health services research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grimes, K.</au><au>Creedon, T.</au><au>Cook, B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Peer‐to‐Peer Family Navigators in Primary Care: Enhancing Child Mental Health Outcomes</atitle><jtitle>Health services research</jtitle><date>2020-08</date><risdate>2020</risdate><volume>55</volume><issue>S1</issue><spage>27</spage><epage>27</epage><pages>27-27</pages><issn>0017-9124</issn><eissn>1475-6773</eissn><abstract>Research ObjectiveOnly 1 in 5 US children with a psychiatric or substance use disorder receives treatment. To investigate the impact of pediatric integrated care, including peer‐to‐peer family support, on identification and engagement of children in an urban safety‐net system.Study DesignWe conducted a prospective, non‐randomized trial comparing clinical functioning and health services utilization outcomes between youths receiving CPM and those receiving usual care. Youths were referred by their pediatricians for child psychiatry evaluation. Each youth’s family was given the option to participate in the 12‐month study following evaluation. Follow‐up observations take place at 6 and 12 months following baseline. Study participants received a multi‐disciplinary, integrated care team evaluation, including peer‐to‐peer parents in the primary care clinic. Claims and electronic medical record data provide information on utilization. We used propensity score weights to balance participants on baseline characteristics and estimated multivariate generalized estimating equations with a difference‐in‐differences framework to produce doubly‐robust estimates of relative pre‐post changes for CPM vs. usual care accounting for clustering of observations within participants.Population StudiedIn the highly diverse population served by this urban safety‐net system, barriers such as stigma, language, and geography create access disparities. Study sample = 171 CPM youth and 290 Controls. All were primary care pediatric patients ages 2 to 17. CPM youth mean age = 10 years; 48.54% identify as female. Study sample families earn <$35 000 a year; over 50 % speak a primary language other than English. Most frequent Diagnosis is Anxiety (39%) for CPM and Depression (33%) for Controls. Childhood trauma: 64% of CPM youth have 3+ ACEs.Principal FindingsRace/Ethnicity: 60.8% of our sample identify as Latinx, 17.0% as non‐Hispanic white, and 16.4% as non‐Hispanic Black/African American. ED Utilization drops 58% from baseline to 6 mos. for CPM youth, compared with 4% decline for controls (P < 0.026). Outpatient MH utilization triples (P = 0.002) for CPM use and doubles (P < 0.001) for controls, at 6 mos. Clinical functioning is assessed via two separate standardized measures (CGAS and CAFAS) and statistically significant change from baseline to 6 mos. is found on both measures. Self‐Harm/Lethality scale showed an average improvement of 71% from baseline to 6 mos. post. Study retention was 88% at 6 months.ConclusionsEmerging evidence indicates improved child mental healthcare outcomes are possible for youth with access and engagement barriers, through the introduction of integrated parent support and child psychiatry consultation within familiar pediatric settings.Implications for Policy or PracticeThese early findings suggest that the Collaborative Practice Model has the potential to improve child mental healthcare access and engagement rates in populations at‐risk for disparities. If further study supports these findings, the effect of early engagement could lead to reduced time to treatment; this, in turn, has the potential to lessen the morbidity burden of childhood trauma or emerging mental illness. If the CPM approach can even partially offset access disparities and support treatment engagement, there is an opportunity to shift service use from more restrictive settings to home and community‐based care.Primary Funding SourceSAMHSA.</abstract><cop>Chicago</cop><pub>Blackwell Publishing Ltd</pub><doi>10.1111/1475-6773.13361</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | At risk populations Baseline studies Child & adolescent mental health Child & adolescent psychiatry Child psychology Children Children & youth Clinical outcomes Electronic medical records Geography Health care Health care access Health status Information processing Integrated delivery systems Language Lethality Mental disorders Mental health Mental health care Minority & ethnic groups Morbidity Navigators Pediatricians Pediatrics Population studies Primary care Special Issue Abstract Special Issue Abstracts Statistical analysis Substance abuse treatment Substance use Trauma |
| title | Peer‐to‐Peer Family Navigators in Primary Care: Enhancing Child Mental Health Outcomes |
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