RESUMEN
With the integration of behavioral health services into primary care and other medical specialties, the community of providers and the public must address a number of questions, including: What models of care are there for these services? What kinds of providers supply these services? Are these providers trained behavioral health providers or extenders in some form? And, as these systems of care are constructed, who makes use of them? The purpose of this study is to address these questions as well as to consider some of the challenges of attending to the spectrum of needs that will arise as integrated healthcare services expand. Consideration of these questions may serve to clarify the impact that these models of healthcare will have in ways that may be readily apparent and, at the same time, in ways that may be subtler and less comprehensible. Addressing these questions is also intended to facilitate discussions within healthcare systems and among providers concerning which models of care best respond to specific populations. In turn, proactively answering these questions will, for the foreseeable future, shape not only behavioral healthcare, in perhaps small or large ways, but also healthcare in general.
Asunto(s)
Medicina de la Conducta , Atención a la Salud/normas , Grupo de Atención al Paciente , Humanos , Asistentes Médicos , Atención Primaria de SaludRESUMEN
This article focuses on the current status of the use of Health and Behavior (H&B) codes by pediatric psychologists. We address the rationale for the use of these codes in a pediatric psychology setting, practice updates since the codes were initiated, and our experience with utilizing these codes in one pediatric hospital. We conclude with a summary of our assertions and future directions for policy and practice.
Asunto(s)
Codificación Clínica/economía , Reembolso de Seguro de Salud/economía , Psicología Infantil/economía , Política de Salud , Humanos , Mecanismo de Reembolso/economíaAsunto(s)
Servicios de Salud del Niño/organización & administración , Servicios de Salud Mental/organización & administración , Niño , Protección a la Infancia/economía , Preescolar , Delaware , Fuerza Laboral en Salud , Humanos , Calidad de la Atención de Salud , Mecanismo de Reembolso , Servicios de Salud Escolar/organización & administraciónRESUMEN
Epidemiological data indicate that nearly 20% of preschool aged children have significant behavioral problems. Parents typically consult their child's primary care provider, who frequently refers to child psychologists for treatment regarding these difficulties. Psychologists skilled in providing effective services for young children are in short supply, limiting accessibility, and parents often are reluctant to follow up with a mental health specialist, suggesting low acceptability. The Behavior Consultation Clinic is a structured clinic for preschool children designed to address these issues of effectiveness, accessibility and acceptability. A retrospective review of 550 patients seen over a 5-year period found that half were seen for one therapy session. Review of the remaining patients found that slightly more than half showed improvement (32% successful discharge with improvement, 24% premature discharge with improvement) with a typical range of two to seven half-hour sessions, about a quarter did not improve, and the remaining patients were referred to a higher level of service. These data indicate that a structured, brief clinic that focuses on the needs of preschool children utilizing evidence-based approaches can be effective, acceptable, and accessible. The Behavior Consultation Clinic also serves as a training clinic for psychology interns and pediatric medical residents.