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The Pediatric Patient-Centered Medical Home: Innovative Models for Improving Behavioral Health
Asarnow JR, Kolko DJ, Miranda J and Kazak AE
American Psychologist, 72:13-27, 2017

The Patient-Centered Medical Home (PCMH) is a care delivery model whereby a patient's primary care physician coordinates their treatment to ensure they receive the necessary care when and where they need it, and in a manner they can understand.

Dr. David Kolko and his colleagues examine the concept of the Patient Centered Medical Home (PCMH) as it applies to children and adolescents in a new article published in the journal American Psychologist. In this article, Dr. Kolko and his co-authors emphasize care for behavioral health conditions, the role of psychology and psychological science, and discuss what next steps need to be taken to develop evidence-informed models for the Pediatric PCMH. 

The PCMH concept for pediatric populations offers unique opportunities for psychological science to inform and enhance the transformation of the United States health care system and to improve healthcare in the United States. The dearth of available evidence on the outcomes of PCMH implementation for children and adolescents underscores the need for additional research evaluating Pediatric-PCMH models and concepts. While behavioral health has only recently been emphasized as a formal part of the PCMH, accumulating evidence supports the effectiveness of some approaches for providing behavioral health care through pediatric primary care. These approaches suggest that a comprehensive Pediatric-PCMH model that includes behavioral health care has the potential to optimize the availability, quality, benefits, and cost-effectiveness of behavioral health services. These approaches could ultimately enhance youth health and behavioral health, with effects potentially extending through the adult years.  

The PCMH model offers unique opportunities for enhancing the health and behavioral health of youth, particularly the economically disadvantaged, minority and uninsured. Continuity of care within a pediatric PCMH and access to a range of professionals provide opportunities to address developmental sensitivities at the most effective time points.  Some of the findings mentioned in this article include those from Dr.  Kolko's clinical trials that documented the clinical efficacy and cost savings of a collaborative care model developed for behavior problems/ADHD (Doctor Office Collaborative Care or DOCC), relative to Enhanced Usual Care, in pediatric primary care practices in Pittsburgh.  

Rigorous research and demonstration projects are still needed to guide further development of optimal strategies for improving health and behavioral health in pediatric populations and advancing the public health impact of behavioral health care services.

Contributors:
David J. Kolko, PhD (Department of Psychiatry, University of Pittsburgh School of Medicine)

Joan Rosenbaum Asarnow, PhD and Jeanne Miranda, PhD (University of California, Los Angeles)

Anne. E. Kazak, PhD (Nemours Children's Health System, Wilmington, Delaware and the Sidney Kimmel Medical School of Thomas Jefferson University)

This article appears in the journal American Psychologist.  View the abstract by clicking here.