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Cited by 545Adolescent and Pediatric HealthcareMental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional Development

Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis

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Asarnow, Joan Rosenbaum, Rozenman, Michelle, Wiblin, Jessica, Zeltzer, Lonnie·2015·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2015.1141
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Abstract

IMPORTANCE: Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health care in the United States and incentivizing integrated medical-behavioral health care as a strategy for improving access to high-quality care for behavioral health conditions, enhancing patient outcomes, and containing costs. OBJECTIVE: To conduct a systematic meta-analysis of randomized clinical trials to evaluate whether integrated medical-behavioral health care for children and adolescents leads to improved behavioral health outcomes compared with usual primary care. DATA SOURCES: Search of the PubMed, MEDLINE, PsycINFO, and Cochrane Library databases from January 1, 1960, through December 31, 2014, yielded 6792 studies, of which 31 studies with 35 intervention-control comparisons and 13,129 participants met the study eligibility criteria. STUDY SELECTION: We included randomized clinical trials that evaluated integrated behavioral health and primary medical care in children and adolescents compared with usual care in primary care settings that met prespecified methodologic quality criteria. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened citations and extracted data, with raw data used when possible. Magnitude and direction of effect sizes were calculated. MAIN OUTCOMES AND MEASURES: Meta-analysis with a random effects model were conducted to examine an overall effect across all trials, and within intervention and prevention trials. Subsequent moderator analyses for intervention trials explored the relative effects of integrated care type on behavioral health outcomes. RESULTS: Meta-analysis with a random-effects model indicated a significant advantage for integrated care interventions relative to usual care on behavioral health outcomes (d = 0.32; 95% CI, 0.21-0.44; P < .001). Moderator analyses indicated larger effects for treatment trials that targeted diagnoses and/or elevated symptoms (d = 0.42; 95% CI, 0.29-0.55; P < .001) relative to prevention trials (d = 0.07; 95% CI, -0.13 to 0.28; P = .49). The probability was 66% that a randomly selected youth would have a better outcome after receiving integrated medical-behavioral treatment than a randomly selected youth after receiving usual care. The strongest effects were seen for treatment interventions that targeted mental health problems and those that used collaborative care models. CONCLUSIONS AND RELEVANCE: Our results, demonstrating the benefits of integrated medical-behavioral primary care for improving youth behavioral health outcomes, enhance confidence that the increased incentives for integrated health and behavioral health care in the US health care system will yield improvements in the health of children and adolescents.

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  • Because few effectiveness trials of parenting programs exist in primary care, the evidence for the effectiveness of such parenting programs while being delivered through primary care is relatively limited.

    “Because few effectiveness trials of these programs exist in primary care, the evidence for the effectiveness of such parenting programs while being delivered through primary care is relatively limited [29].”

    From “Scaling-out” evidence-based interventions to new populations or new health care delivery systems (2017) · cites this paper as [29]

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Cited by

Sorted by citations

Authors
Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Asarnow, Joan Rosenbaum
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2015-10-01
Volume
169
Issue
10
Pages
929
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2015.1141
OpenAlex
W1660283423
Cited by
545
References
13
Citations by year
2026: 34 · 2025: 47 · 2024: 53 · 2023: 48 · 2022: 56 · 2021: 59 · 2020: 53 · 2019: 57 · 2018: 56 · 2017: 44 · 2016: 31 · 2015: 7
FWCI
10.23
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01MH078596, MH078596)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
collaborative care, psychotherapy, prevention, health care access, health care financing, health care legislation
MeSH terms
Child Health, Adolescent Health, Adolescent, Adolescent Behavior, Child, Child Behavior, Child Health Services, Humans, Primary Health Care, United States, Randomized Controlled Trials as Topic, Adolescent Health Services

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