Nebraska Pediatric Integrated Care Training (NE-PICT) Model

Abstract

Objective: The Nebraska Pediatric Integrated Care Training (NE-PICT) model of training was initiated in 1997 to meet the behavioral health needs of youth throughout the state of Nebraska, as well as to prepare the future behavioral health workforce to practice in primary care settings. In 2011, the NE-PICT program was identified by the Health Resources and Services Administration (HRSA) as 1 of 9 promising practices in rural mental health delivery. The purpose of this article is to describe the NE-PICT model of training. Method: NE-PICT was developed to increase the capacity of behavioral health providers equipped to address the majority of behavioral health needs of youth presenting in primary care. Training includes a combination of didactic and in-clinic modeling with supervising NE-PICT university trainers. Results: Over 200 doctoral-level interns, 400 master’s level interns, and 80 postdoctoral fellows have completed training through the NE-PICT model in over 40 primary care clinics since the program’s inception. Conclusions: The NE-PICT has helped to grow the behavioral health workforce in primary care settings in Nebraska and beyond.

Implications for Impact Statement

There is a substantial need in this country to address the behavioral health needs of youth, particularly in rural and underserved areas, because of the shortage of clinicians. The Nebraska Pediatric Integrated Care Training (NE-PICT) model has been pivotal in training a behavioral health workforce prepared to integrate into primary care settings to address the behavioral health needs of youth in rural and underserved areas of the United States.

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References

AIMS Center . (2013). Principles of effective integrated primary care. Retrieved from https://aims.uw.edu/collaborative-care/principles-collaborative-care

Alegria

Vallas

Pumariega

A. J.

(2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19, 759–774. 10.1016/j.chc.2010.07.001

Asarnow

J. R.

Rozenman

Wiblin

Zeltzer

(2015). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. Journal of the American Medical Association Pediatrics, 169, 929–937. 10.1001/jamapediatrics.2015.1141

Association of Psychology Postdoctoral and Internship Centers . (2019, August 16). APPIC match statistics. Retrieved from https://appic.org/Internships/Match/Match-Statistics

Behavioral Health Education Center of Nebraska . (2015). Fiscal year 2014 and fiscal year 2015 legislative report. Omaha, NE: University of Nebraska Medical Center.

Blount

(2003). Integrated primary care: Organizing the evidence. Families, Systems, & Health, 21, 121–133. 10.1037/1091-7527.21.2.121

Briggs-Gowan

M. J.

Horwitz

S. M.

Schwab-Stone

M. E.

Leventhal

J. M.

Leaf

P. J.

(2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 841–849. 10.1097/00004583-200007000-00012

Bureau of Health Workforce, Health Resources and Services Administration . (2019). Designated health professional shortage areas statistics: Fourth quarter of fiscal year 2019 designated HPSA quarterly summary. Rockville, MD: U. S. Department of Health and Human Services. Retrieved from https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport

Christophersen

E. R.

Mrtweet

(2011). Treatments that work with children: Empirically supported strategies for managing childhood problems. Washington DC: American Psychological Association.

10.

Connors

E. H.

Arora

Blizzard

A. M.

Bower

Coble

Harrison

. . . Wissow

(2018). When behavioral health concerns present in pediatric primary care: Factors influencing provider decision-making. The Journal of Behavioral Health Services & Research, 45, 340–355. 10.1007/s11414-017-9580-9

11.

Cree

R. A.

Bitsko

R. H.

Robinson

L. R.

Holbrook

J. R.

Danielson

M. L.

Smith

. . . Peacock

(2018). Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2–8 years—United States, 2016. Morbidity and Mortality Weekly Report, 67, 1377–1383. 10.15585/mmwr.mm6750a1

12.

Ghandour

R. M.

Sherman

L. J.

Vladutiu

C. J.

Ali

M. M.

Lynch

S. E.

Bitsko

R. H.

Blumberg

S. J.

(2019). Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics, 206, 256–267. 10.1016/j.jpeds.2018.09.021

13.

Hayden

E. P.

Mash

E. J.

(2014). Child psychopathology: A developmental-systems perspective. In Mash

E. J.

& Barkley

R. A.

(Eds.), Child psychopathology (pp. 3–72). New York, NY: Guilford Press.

14.

Health Resources and Services Administration . (2020). Shortage areas. Retrieved from https://data.hrsa.gov/topics/health-workforce/shortage-areas

15.

Heath

Wise Romero

Reynolds

K. A.

(2013). A review and proposed standard framework for levels of integrated healthcare. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions.

16.

Hoffses

K. W.

Ramirez

L. Y.

Berdan

Tunick

Honaker

S. M.

Meadows

T. J.

. . . Stancin

(2016). Topical review: Building competency: Professional skills for pediatric psychologists in integrated primary care settings. Journal of Pediatric Psychology, 41, 1144–1160. 10.1093/jpepsy/jsw066

17.

Hoge

M. A.

Morris

J. A.

Laraia

Pomerantz

Farley

(2014). Core competencies for integrated behavioral health in primary care. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions.

18.

Howell

McFeeters

(2008). Children’s mental health care: Differences by race/ethnicity in urban/rural areas. Journal of Health Care for the Poor and Underserved, 19, 237–247.

19.

HRSA . (2011). Rural behavioral health programs and promising practices. Rockville, MD: Office of Rural Health Policy.

20.

Knopf

Park

M. J.

Mulye

T. P.

(2008). The mental health of adolescents: A national profile, 2008. San Francisco, CA: National Adolescent Health Information Center.

21.

Kolko

D. J.

Campo

Kilbourne

A. M.

Hart

Sakolsky

Wisniewski

(2014). Collaborative care outcomes for pediatric behavioral health problems: A cluster randomized trial. Pediatrics, 133, e981–e992. 10.1542/peds.2013-2516

22.

Kolko

D. J.

Campo

J. V.

Kilbourne

A. M.

Kelleher

(2012). Doctor-office collaborative care for pediatric behavioral problems: A preliminary clinical trial. Archives of Pediatrics & Adolescent Medicine, 166, 224–231. 10.1001/archpediatrics.2011.201

23.

Larson

E. H.

Patterson

D. G.

Garberson

L. A.

Andrilla

C. H. A.

(2016). Supply and distribution of the behavioral health workforce in rural America (Data Brief 160). Seattle, WA: WWAMI Rural Health Research Center, University of Washington.

24.

Meadows

Valleley

Haack

M. K.

Thorson

Evans

(2011). Physician “costs” in providing behavioral health in primary care. Clinical Pediatrics, 50, 447–455. 10.1177/0009922810390676

25.

Nelson

E. L.

Bui

(2010). Rural telepsychology services for children and adolescents. Journal of Clinical Psychology, 66, 490–501. 10.1002/jclp.20682

26.

Palermo

T. M.

Janicke

D. M.

McQuaid

E. L.

Mullins

L. L.

Robins

P. M.

Y. P.

(2014). Recommendations for training in pediatric psychology: Defining core competencies across training levels. Journal of Pediatric Psychology, 39, 965–984. 10.1093/jpepsy/jsu015

27.

Perou

Bitsko

R. H.

Blumberg

S. J.

Pastor

Ghandour

R. M.

Gfroerer

J. C.

. . . Centers for Disease Control and Prevention . (2013). Mental health surveillance among children—United States, 2005–2011. MMWR Supplements, 62, 1–35.

28.

Polanczyk

G. V.

Salum

G. A.

Sugaya

L. S.

Caye

Rohde

L. A.

(2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56, 345–365. 10.1111/jcpp.12381

29.

Reardon

Harvey

Baranowska

O’Brien

Smith

Creswell

(2017). What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. European Child & Adolescent Psychiatry, 26, 623–647. 10.1007/s00787-016-0930-6

30.

Ross

K. M.

Klein

Ferro

McQueeney

D. A.

Gernon

Miller

B. F.

(2019). The cost effectiveness of embedding a behavioral health clinician into an existing primary care practice to facilitate the integration of care: A prospective, case-control program evaluation. Journal of Clinical Psychology in Medical Settings, 26, 59–67. 10.1007/s10880-018-9564-9

31.

Sturm

Stancin

(2013). Competencies for pediatric psychology practice in primary care: A work in progress. Retrieved from http://www.apa.org/pi/families/resources/primary-care/competencies.aspx

32.

Valleley

R. J.

Kosse

Schemm

Foster

Evans

Polaha

(2007). Integrated primary care for children in rural communities: An examination of patient attendance at collaborative behavioral health services. Families, Systems, & Health, 25, 323–332. 10.1037/1091-7527.25.3.323

33.

Weisz

J. R.

Kazdin

A. E.

(Eds). (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York, NY: The Guilford Press.

34.

Whitney

D. G.

Peterson

M. D.

(2019). U.S. national and state-level prevalence of mental health disorders and disparities of mental health care use in children. Journal of the American Medical Association Pediatrics, 173, 389–391. 10.1001/jamapediatrics.2018.5399

35.

Murphy

S. L.

Kochanek

K. D.

Bastian

Arias

(2018). Deaths: Final data for 2016. National Vital Statistics Reports, 67, 1–76.