Pediatric Primary Care Perspectives on Integrated Mental Health Care for Autism

Nicole A Stadnick, Kassandra Martinez, Gregory A Aarons, David A Lee, Jeanne Van Cleave, Lauren Brookman-Frazee, Nicole A Stadnick, Kassandra Martinez, Gregory A Aarons, David A Lee, Jeanne Van Cleave, Lauren Brookman-Frazee

Abstract

Objective: Timely identification of mental health needs and linkage to services is critical to provide comprehensive care for children with autism spectrum disorder (ASD). Pediatric primary care is well-positioned to facilitate this process through integrated care approaches. As a first step toward mental health integration, this study applied the Exploration, Preparation, Implementation, and Sustainment framework to characterize determinants of implementing integrated care practices for ASD.

Methods: Sixty pediatric primary care providers and leaders from 3 organizations completed focus groups and surveys about identification of mental health needs in children with ASD and access to mental health services. Findings were integrated to examine convergence (ie, do the 2 methods confirm or find similar results) and expansion (ie, do the 2 methods provide insights beyond either method alone).

Results: Results converged regarding 3 primary influences to integrated care practices for ASD: 1) limited specialized mental health referral options for ASD, 2) unique structural characteristics of the mental health system act as barriers to accessing care, and 3) caregivers differ in the degree to which they understand co-occurring mental health conditions and pursue recommended services. Qualitative results provided expansion by highlighting unique implementation considerations (eg, alignment with health care delivery priorities and values) based on primary care characteristics.

Conclusions: Findings confirm need for a tailored approach for linking children with ASD to appropriate mental health treatment. Results yield insight into the needs for organizational capacity to support integrated care and provide direction toward adapting an integrated mental health care model for children with ASD.

Keywords: autism; implementation science; integrated care; mental health; pediatrics; primary care.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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