Jodi Polaha

Parental Report of Medication Acceptance Among Youth : Implications for Everyday Practice

Objective: Evidence-based interventions for pill swallowing training exist but are primarily implemented in pediatric specialty hospitals. Given increasing interest in the translation of brief and effective interventions to the wider population, there is a need to examine medication acceptance in a normative sample. Methods: Participants (N = 304) completed the Medication Acceptance Survey, which assessed child/adolescent liquid and pill medication history and acceptance as well as parental interest in pill swallowing training. Results: Results showed that 30–40% of youth had rejected/refused a pill or liquid formulation. Over half were unable to swallow a standard size pill or small capsule. Despite these difficulties, most parents did not express interest in an empirically supported pill swallowing training intervention. Conclusions: The results provide directions for future research as well as the translation of pill swallowing interventions to primary care.

Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action

The Primary Care Behavioral Health (PCBH) model of service delivery is being used increasingly as an effective way to integrate behavioral health services into primary care. Despite its growing popularity, scientifically robust research on the model is lacking. In this article, we provide a qualitative review of published PCBH model research on patient and implementation outcomes. We review common barriers and potential solutions for improving the quantity and quality of PCBH model research, the vital data that need to be collected over the next 10 years, and how to collect those data.

Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost.

Objectives Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not. Methods Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers’ direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated. Results On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected

Using Implementation Science to Guide the Integration of Evidence-Based Family Interventions into Primary Care

1142 more revenue than on days when no consultant was present. Conclusions The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.

Dissemination and Implementation Science: Research for the Real-World Medical Family Therapist

This article is a demonstration of how an implementation-science (IS) framework can be coupled with the measurement of implementation outcomes to effectively integrate evidence-based family interventions in primary care. The primary care environment presents a number of challenges for successfully integrating such interventions. However, IS methods can improve the prospect of successfully implementing a new intervention while simultaneously and rigorously evaluating the impact on salient outcomes. We used our experiences across 2 pilot trials in which the family check-up (Smith, Montaño, Mauricio, Berkel, & Dishion, 2016), an evidence-based family intervention, was integrated into primary care. In these pilot trials, the exploration, preparation, implementation, and sustainment (EPIS) framework and the Proctor et al. taxonomy of implementation outcomes were used to guide the implementation and evaluate its success. Grounding our presentation in our pilot work offers an illustration of applying the EPIS framework and outcomes measurement to real-world problems and contexts. When embarking on new efforts to integrate behavioral interventions into health-care settings, the application of IS frameworks and measurement strategies can create generalizable knowledge that substantively contributes to a sparse literature. Today, those “in the trenches” who are translating evidence-based interventions to their setting can contribute to the corpus of research in integrated care by using IS methods to plan a new program and evaluate its feasibility, adoption, and reach.

Identifying Unbiased Items for Screening Preschoolers for Disruptive Behavior Problems

Dissemination and Implementation (D&I) Science is an evolving field of models and methods aimed at closing the research-practice gap. This chapter provides an overview of D&I Science with particular emphasis on its relevance for academic and clinical medical family therapists (MedFTs) and/or graduate students in training. It begins with a discussion of the poor reach of evidence-based treatments, building a case for the evolution of D&I Science. Basic definitions of dissemination research and implementation research are provided, followed by a description of the characteristics of D&I Science. Two exemplary D&I models are described with examples that relate to MedFT. The chapter closes with a discussion about how the reader can learn more about this dynamic and growing field.

The Prevalence of Emotional and Behavior Problems in Pediatric Primary Care Serving Rural Children

Objective Efficient identification and referral to behavioral services are crucial in addressing early-onset disruptive behavior problems. Existing screening instruments for preschoolers are not ideal for pediatric primary care settings serving diverse populations. Eighteen candidate items for a new brief screening instrument were examined to identify those exhibiting measurement bias (i.e., differential item functioning, DIF) by child characteristics. Method Parents/guardians of preschool-aged children ( N = 900) from four primary care settings completed two full-length behavioral rating scales. Items measuring disruptive behavior problems were tested for DIF by child race, sex, and socioeconomic status using two approaches: item response theory-based likelihood ratio tests and ordinal logistic regression. Results Of 18 items, eight were identified with statistically significant DIF by at least one method. Conclusions The bias observed in 8 of 18 items made them undesirable for screening diverse populations of children. These items were excluded from the new brief screening tool.