Effects of Primary Care Provider Characteristics on Changes in Behavioral Health Delivery During a Collaborative Care Trial

Abstract

Objective: Pediatric primary care providers (PCPs) are increasingly expected to deliver behavioral health (BH) services, yet PCP characteristics that facilitate or hinder BH service delivery are poorly understood. This study examined how PCP characteristics and collaborative care participation influenced changes in BH-related effort and competency over time.

Methods: Pediatric PCPs (N = 74) participating in a cluster randomized trial (8 practices) of a collaborative care intervention for disruptive behavior problems completed self-report measures at 0, 6, 12, and 18 months. Latent growth curve models tested the impact of PCP characteristics (ie, age, gender, negative BH beliefs, BH burden, BH competency) on changes in identification/treatment of disruptive behavior disorders and competency over the course of the trial.

Results: Participation in collaborative care was associated with increases in identification/treatment, with no evidence that PCP characteristics moderated changes in identification/treatment. For competency, however, older PCPs (>50 years) in collaborative care exhibited steep increases over time, while older PCPs in the comparison condition exhibited steep decreases, suggesting differential benefits of collaborative care participation by PCP age. In both conditions, PCPs with more negative BH beliefs reported less identification/treatment over time. Baseline competency was positively associated with identification/treatment and associations weakened over time. Gender and perceived burden had little impact.

Conclusions: PCP characteristics are associated with changes in PCPs' BH-related effort and competency over time. Participation in a collaborative care model appears to be especially beneficial for older PCPs. Implementation of collaborative care can promote growth in BH-related effort and competency for PCPs.

Keywords: behavioral health; collaborative care; pediatrics.

Copyright © 2019 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

Interactions involving intervention condition and time. A: Interaction between condition and time predicting identification/treatment. B: Interaction between age, condition, and time predicting competency. BL = Baseline.

Figure 2:

Interactions between PCP characteristics and time predicting identification/treatment. A: Interaction between age and time predicting identification/treatment. B: Interaction between negative beliefs and time predicting identification/treatment. C: Interaction between competency and time predicting identification/treatment.