A meaningful and growing body of research shows that the Collaborative Care approach produces better outcomes for patients ages 6-17 when compared to usual, non-integrated behavioral health care. So it’s no surprise that the utilization of the model continues to grow within pediatrics.
A decade ago JAMA Pediatrics published a meta-analysis of dozens of studies on integrated behavioral health care in children and adolescents. In the results, they note that “The strongest effects were seen for treatment interventions that targeted mental health problems and those that used collaborative care models.”
More recently, research conducted by Karl Vanderwood (JG Research & Evaluation) and Concert Health researchers Virna Little, PsyD, LCSW-r, and Jian Joyner, LSW, zoomed in on Collaborative Care in adolescent pediatrics. The research is an analysis of de-identified national data from Concert Health, and is based on 493 adolescents (ages 12-17) diagnosed with depression or anxiety. Patients were deemed to have a “successful” treatment episode by their clinician and if they achieved a 50% reduction in their depression or anxiety scores at 90 and 120 days – a commonly recognized clinical standard for improvement.
The findings are separated based on whether the patients filled out the PHQ-9 or GAD-7, and the results are revealing:
- Depression (PHQ-9 Group): 70.7% of patients achieved a successful outcome at discharge. At 120 days, 62.4% of patients saw their depression scores reduced by at least 50%.
- Anxiety (GAD-7 Group): 67.4% of patients achieved a successful outcome at discharge. At 120 days, 53.5% of patients had their anxiety scores reduced by at least 50%.
These results are comparable to outcomes observed in adult populations who received interventions through a Collaborative Care approach. And just like adults, a key factor in adolescents achieving a measurable improvement for both anxiety and depression patients was the number of clinical touchpoints (interactions with the care manager). Patients with more frequent sessions were significantly more likely to have a successful outcome. But there are also some important differences specific to pediatrics.
How Pediatrics Is Different
As pediatricians remind us, children and adolescents are not simply adults in miniature. There are special considerations that are different from adult populations to ensure that a Collaborative Care approach will be effective.
The Frontiers paper suggests that the age of the adolescent is highly predictive of success. For patients being treated for anxiety, being older at enrollment (closer to 17 years of age) was associated with a higher likelihood of success. This suggests that older adolescents may be better equipped to engage in the telephonic, short-term, symptom-focused activities inherent to the model. It’s also a watch-out for younger children and suggests they be viewed differently.
But how a Collaborative Care program is structured and how care is delivered also impacts success for children and adolescents. In a detailed paper “Pediatric Collaborative Care Implementation Guide” researchers at the AIMS Center at the University of Washington speak to the model’s efficacy with kids, and they note that: “CoCM’s emphasis on engagement for both the patient and their family, shared decision-making on evidence-based treatment options, use of psychoeducational materials with the patient and their family, and consideration for treatment accessibility, demonstrated adolescent depression symptom improvement of 50% after 12 months in treatment, compared to 20% improvement in care as usual. Treating children ages 5 and up with behavior concerns, ADHD, and anxiety in CoCM has also been found to be feasible and broadly effective.”
For pediatric populations, the guide points out some considerations for supporting children and adolescents as different from working with adults. To list just a few:
- Scheduling: Structure touch-points in a way that keeps school/active hours in mind.
- Screening and Symptom Monitoring: Use clinical instruments validated for this age group for symptom screening and monitoring.
- Caseload Adjustment: Pediatric caseloads tend to be smaller, often to incorporate collateral and natural supports (e.g., parents, caregivers, schools, social services)
- Age-Appropriate Treatments: Treatment approaches, including medications, are often very different for children (vs. adults), so having pediatric psychiatry expertise on the team is crucial.
There are playbooks and toolkits that organizations develop specifically around delivering Collaborative Care interventions to children and adolescents. At Concert Health, clinical leaders continue to advance and refine the Pediatric Pathway, which supports clinicians by integrating the latest evidence, contributing to the growing body of research on Collaborative Care in youth, and ensuring our approach reflects developmentally appropriate, evidence-based best practices for our youngest patients.