Implementation strategies in co-located, coordinated, and collaborative care models for child and youth mental health concerns

Time has come for integrated care and over the past 30 years a broad array of approaches have been implemented across the country, and internationally, both with adults and youth. The approach has struck a chord with pediatric primary care clinicians (PPCCs), child psychiatrists, psychologists, other mental health (MH) workers, governments, insurers, corporations, and the public. Approaches can be considered as a continuum, from coordinated, to co-located, to collaborative or fully integrated programs. Each level is described and reviewed. There are strengths and weaknesses for each approach, yet all aim to increase access to care, to support primary care to expand their scope of work, and to promote integration between medical and behavioral health services. Coordinated programs, often referred to as child psychiatry access programs in the US have seen widespread adoption and are feasible, well received, but require subsidization by grants or contracts. Co-located programs can be more easily self-sustaining but depend more on the individuals involved and are administratively separate from the primary care practice. Collaborative care is the most complex and integrated of programs but is the most expensive as well. Limited research has best supported collaborative care and more research is clearly needed to establish the effectiveness of these programs for patients, PPCCs, population health, and MH professionals. While most integrated care programs are based in the US and Canada, concepts of integrated care are beginning to be implemented globally. The arc of history appears to be bending towards greater integration and future systems of payment will be critical in determining the speed with which this occurs.