Extending Collaborative Care to Independent Primary Care Practices: A Chronic Care Model

Abstract

Objective: Collaborative approaches to pediatric primary care are increasingly recognized as a way to improve access to mental health care, but certain collaborative care models are not well suited for smaller, independent pediatric practices. We describe the development of the Mood, Anxiety, ADHD Collaborative Care (MAACC) program, based on the Chronic Care Model (CCM) and a hub-and-spoke organization for collaborating with such practices. Method: MAACC’s clinical team (coordinator, psychologist, psychiatrist) trained and collaborated with 46 pediatricians in 13 independent practices. Key services included a diagnostic evaluation by the psychologist, treatment planning for both psychotherapy and pharmacotherapy, tailored referrals to evidence-based therapy, pediatrician access to a psychiatrist for medication consultation, and centralized measurement-based progress monitoring. Results: During the 15-month start-up period, 234 patients were referred; 149 patients received an evaluation, 83 received a new referral for therapy, and 88 received medication recommendations for combined psychotherapy and medication. Patients experienced significant improvement in attention deficit/hyperactivity disorder and anxiety disorder symptoms. Pediatrician attitudes and access to care substantially improved. Conclusion: MAACC demonstrates the feasibility of implementing a CCM-derived model for collaborative care with independent pediatric practices.

Implications for Impact Statement

Collaboration among mental health and pediatric primary care providers is essential to addressing the substantial pediatric mental health burden. Financially sustainable extensions of collaborative care models to small, independent pediatric practices are needed. The Mood, Anxiety, ADHD Collaborative Care program is a high-quality collaborative model designed for pediatric primary care.