Follow up care after an abnormal developmental screening may be challenging for families, particularly those from under resourced communities. In this study, we examined how an existing integrated primary care (IPC) co-located model could address the needs of families whose children faced developmental concerns by conducting qualitative interviews to inform the adaptation to include developmental services. Data from 51 caregivers of pediatric patients (4 months to 6 years old) were analyzed qualitatively and coded using the Consolidated Framework for Implementation Research (CFIR) in combination with grounded theory to identify themes. Following coding with the CFIR framework, a thematic analysis was conducted for overarching themes in the data with the gradual development of codes and categories in an inductive manner. The thematic analyses identified three major themes: components of effective referrals, barriers, and caregiver preferences. The current study provides in-depth, contextualized information about how current IPC models can be expanded to address developmental concerns.
RadeckiLSand-LoudNO’ConnorKGSharpSOlsonLM. Trends in the use of standardized tools for developmental screening in early childhood: 2002–2009. Pediatrics. 2011;128(1):14-19.
2.
Council on Children With Disabilities; Section on Developmental Behavioral Pediatrics; Bright Futures Steering Committee; Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics. 2006;118(1):405-420.
3.
StormontM. Externalizing behavior problems in young children: contributing factors and early intervention. Psychol Sch. 2002;39(2):127-138.
4.
NewacheckPHungY-YHochsteinMHalfonN. Access to health care for disadvantaged young children. J Early Interv. 2002;25(1):1-11.
5.
XuGFieldsSKLaineCVeloskiJJBarzanskyBMartiniCJ. The relationship between the race/ethnicity of generalist physicians and their care for underserved populations. Am J Public Health. 1997;87(5):817-822.
6.
BegeerSBoukSEBoussaidWTerwogtMMKootHM. Underdiagnosis and referral bias of autism in ethnic minorities. J Autism Dev Disord. 2009;39(1):142-148.
7.
OrtegaANStewartDCDowshenSAKatzSH. Perceived access to pediatric primary care by insurance status and race. J Community Health. 2000;25(6):481-493.
8.
TrudeSStoddardJJ. Referral gridlock: primary care physicians and mental health services. J Gen Intern Med. 2003;18(6):442-449.
9.
ReichardASaccoTMTurnbullHR3rd. Access to health care for individuals with developmental disabilities from minority backgrounds. Ment Retard. 2004;42(6):459-470.
10.
AsarnowJRRozenmanMWiblinJZeltzerL. Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: a meta-analysis. JAMA Pediatr. 2015;169(10):929-937.
11.
HerbstRBMargolisKLMillarAMMutherEFTalmiA. Lost in translation: identifying behavioral health disparities in pediatric primary care. J Pediatr Psychol. 2016;41(4):481-491.
12.
NjorogeWFHostutlerCASchwartzBSMautoneJA. Integrated behavioral health in pediatric primary care. Curr Psychiatry Rep. 2016;18:1-8.
13.
AsarnowJRKolkoDJMirandaJKazakAE. The pediatric patient-centered medical home: innovative models for improving behavioral health. Am Psychol. 2017;72(1):13-27.
14.
KolkoDJCampoJKilbourneAMHartJSakolskyDWisniewskiS. Collaborative care outcomes for pediatric behavioral health problems: a cluster randomized trial. Pediatrics. 2014;133(4):e981-e992.
15.
BuchholzMFischerCMargolisKLTalmiA. Early childhood behavioral health integration in pediatric primary care. Zero Three. 2016;36:4-10.
16.
BuchholzMBurnettBMargolisKLMillarATalmiA. Early childhood behavioral health integration activities and HealthySteps: sustaining practice, averting costs. Clin Pract Pediatr Psychol. 2018;6(2):140-151.
17.
StancinTPerrinEC. Psychologists and pediatricians: opportunities for collaboration in primary care. Am Psychol. 2014;69(4):332-343.
18.
WestfallJMJabbarpourYKuwaharaR, et al. The state of integrated primary care and behavioral health in the United States Robert Graham center. Accessed May 31, 2022. https://www.graham-center.org/home.html
19.
ClayRA. Etiquette for integrated care. Monit Psychol. 2018;49(7):70.
20.
PosavacEJ. Program Evaluation: Methods and Case Studies. New York, NY: Routledge; 2015.
21.
DamschroderLJAronDCKeithREKirshSRAlexanderJALoweryJC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science. 2009;4(1):50.
22.
DamschroderLJReardonCMWiderquistMAOLoweryJ. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75.
23.
BraunVClarkeV. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.
24.
PidanoAESegoolNKDelgadoN, et al. Parent perceptions of pediatric primary care providers’ mental health–related communication and practices. J Pediatr Health Care. 2020;34(5):e49-e58.
25.
ValleleyRJKosseSSchemmAFosterNPolahaJEvansJH. Integrated primary care for children in rural communities: an examination of patient attendance at collaborative behavioral health services. Fam Syst Health. 2007;25(3):323-332.
26.
MarshallJRaffaele MendezLMSingletonDL. Barriers and facilitators to parental help-seeking for young children with developmental delays: a qualitative investigation. J Early Interv. 2020;42(2):182-198.
27.
LockeJIbanezLVPosnerEFrederickLCarpentierPStoneWL. Parent perceptions about communicating with providers regarding early autism concerns. Pediatrics. 2020;145(suppl 1):S72-S80.
28.
FloresG; Committee on Pediatric Research. Racial and ethnic disparities in the health and health care of children. Pediatrics. 2010;125(4):e979-e1020.
29.
StevensGDShiL. Racial and ethnic disparities in the primary care experiences of children: a review of the literature. Med Care Res Rev. 2003;60(1):3-30.
30.
HiraiAHKoganMDKandasamyVReulandCBethellC. Prevalence and variation of developmental screening and surveillance in early childhood. JAMA Pediatr. 2018;172(9):857-866.
