Pediatric Research In Service Models (PRISM)

Problem

Despite significant negative effects for the child and their family, only 5% of children 4-17 years old who need mental health treatment receive treatment other than medication for emotional or behavioral difficulties (Simpson et al., 2008). One contributing factor to this problem is lack of identification of children in need. Pediatricians are in an optimal position to assist with early identification of behavioral and emotional problems in children; and further such care offered in or coordinated by the pediatrician's office may be more feasible and effective.

• To create an infrastructure for integrating the delivery of mental health services into pediatric primary care first at Rowan Medicine., and later at Cooper Hospital.
• To assess the efficacy of four different health care delivery models that vary along a dimension of ease of access on behavioral health of children 4-8 years of age with externalizing behavior problems. The four health care delivery models that will be compared in a small randomized pilot study will be:
  • services delivered in the physical location of the practice
  • services delivered via Video Conferencing methodology
  • services delivered in the home
  • treatment as usual (i.e., refer patients to a provider)
  The intervention (Parent-Child Interaction Therapy (PCIT)) and therapist will be the same across service delivery models; the intervention will consist of 10 sessions delivered in a maximum of 12 weeks. We will be assessing treatment efficacy, treatment engagement, cost-effectiveness as well as parent, physician, and therapist satisfaction at end of treatment and at 3-months follow-up.
• To create a user-friendly survey instruments that may allow pediatricians to better identify children in their practices who are experiencing emotional and behavioral health issues. Both parents and pediatricians will complete a screening tool used to identify externalizing behavior in children (Pediatric Symptom Questionnaire (PSQ)). Our goal is to identify which questions on the screening tool will allow pediatricians to identify children in need of services.
• To develop a training program for workforce development in the delivery of integrated care. This training program will involve medical students, residents, fellows, and graduate students in mental health counseling and applied behavior analysis.

This project is funded by an internal SEED grant from Robert Wood Johnson Foundation to MaryLou Kerwin, Ph.D., BCBA-D (PI) and Michelle Soreth, Ph.D., BCBA-D (Co-I).