Fifty percent of children do not receive care for their mental health concerns, while 95% are seen annually within primary care by age 6. Individual, cultural, and systemic barriers limit access to mental health care. Integrating mental health services into primary care has the potential to increase awareness, reduce costs, and decrease stigma. However, integrated primary care often relies on a brief and targeted intervention approach that may not be suitable for all families. Therefore, it is important to examine differential outcomes within this setting. Methods: This study analyzed retrospective data from 3,494 new patient medical records at a large university medical center (Michigan Medicine, University of Michigan) and its six satellite clinics. These clinics were staffed by pediatricians, psychologists, and graduate-level trainees. A structured, multiple-response questionnaire was developed by the center’s senior staff and administered during therapy sessions. Results: A latent class analysis based on demographics, presenting concerns, medical history, and psychosocial risk factors was conducted using Mplus software. The results indicated a four- class solution: Broad Presentation + Psychosocial Risk, High Behavioral Risk, Attention-Related Concerns, and Depression-Anxiety. Covariates were assigned to the model using the auxiliary function to assess group differences. Results indicated that the Broad Presentation + Psychosocial Risk class demonstrated greater symptom improvements than the High Behavioral Risk class, χ²(1) = 6.73, p = .009, and higher session utilization than the Depression-Anxiety class, χ²(1) = 4.17, p = .041. Conclusions: These findings underscore the value of integrated mental health within primary care and suggest that these services may be particularly beneficial for the most at-risk patients with broad symptom presentations and multiple barriers to care
","abstract_html":"<p>Fifty percent of children do not receive care for their mental health concerns, while 95% are seen annually within primary care by age 6. Individual, cultural, and systemic barriers limit access to mental health care. Integrating mental health services into primary care has the potential to increase awareness, reduce costs, and decrease stigma. However, integrated primary care often relies on a brief and targeted intervention approach that may not be suitable for all families. Therefore, it is important to examine differential outcomes within this setting. Methods: This study analyzed retrospective data from 3,494 new patient medical records at a large university medical center (Michigan Medicine, University of Michigan) and its six satellite clinics. These clinics were staffed by pediatricians, psychologists, and graduate-level trainees. A structured, multiple-response questionnaire was developed by the center’s senior staff and administered during therapy sessions. Results: A latent class analysis based on demographics, presenting concerns, medical history, and psychosocial risk factors was conducted using Mplus software. The results indicated a four- class solution: Broad Presentation + Psychosocial Risk, High Behavioral Risk, Attention-Related Concerns, and Depression-Anxiety. Covariates were assigned to the model using the auxiliary function to assess group differences. Results indicated that the Broad Presentation + Psychosocial Risk class demonstrated greater symptom improvements than the High Behavioral Risk class, χ²(1) = 6.73, p = .009, and higher session utilization than the Depression-Anxiety class, χ²(1) = 4.17, p = .041. Conclusions: These findings underscore the value of integrated mental health within primary care and suggest that these services may be particularly beneficial for the most at-risk patients with broad symptom presentations and multiple barriers to care</p>","abstract_has_math":false,"creators":["Glownia, Karen"],"institution":null,"degree_name":"Doctor of Philosophy (PhD)","degree_level":"Open Access Dissertation","degree_discipline":"Psychology","degree_department":null,"school":null,"contributors":["Heather Janisse, Ph.D.","Jamie Lawler, Ph.D","Elizabeth Neilson, Ph.D."],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-01-01T08:00:00Z","date_published":"2025-01-01T08:00:00Z","updated_at":"2026-07-24T02:17:53Z","subjects":["integrated primary care","latent class analysis","pediatric mental health","treatment outcomes","Clinical Psychology"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://commons.emich.edu/theses/1315","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Heather Janisse, Ph.D.","Jamie Lawler, Ph.D","Elizabeth Neilson, Ph.D."]},{"key":"dc:creator","label":"Author","values":["Glownia, Karen"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2025-10-07T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Psychology"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Open Access Dissertation"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Philosophy (PhD)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["integrated primary care","latent class analysis","pediatric mental health","treatment outcomes","Clinical Psychology"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://commons.emich.edu/theses/1315"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Fifty percent of children do not receive care for their mental health concerns, while 95% are seen annually within primary care by age 6. Individual, cultural, and systemic barriers limit access to mental health care. Integrating mental health services into primary care has the potential to increase awareness, reduce costs, and decrease stigma. However, integrated primary care often relies on a brief and targeted intervention approach that may not be suitable for all families. Therefore, it is important to examine differential outcomes within this setting. Methods: This study analyzed retrospective data from 3,494 new patient medical records at a large university medical center (Michigan Medicine, University of Michigan) and its six satellite clinics. These clinics were staffed by pediatricians, psychologists, and graduate-level trainees. A structured, multiple-response questionnaire was developed by the center’s senior staff and administered during therapy sessions. Results: A latent class analysis based on demographics, presenting concerns, medical history, and psychosocial risk factors was conducted using Mplus software. The results indicated a four- class solution: Broad Presentation + Psychosocial Risk, High Behavioral Risk, Attention-Related Concerns, and Depression-Anxiety. Covariates were assigned to the model using the auxiliary function to assess group differences. Results indicated that the Broad Presentation + Psychosocial Risk class demonstrated greater symptom improvements than the High Behavioral Risk class, χ²(1) = 6.73, p = .009, and higher session utilization than the Depression-Anxiety class, χ²(1) = 4.17, p = .041. Conclusions: These findings underscore the value of integrated mental health within primary care and suggest that these services may be particularly beneficial for the most at-risk patients with broad symptom presentations and multiple barriers to care
"]},{"key":"dc:title","label":"Title","values":["Integrated behavioral health in pediatric primary care: Identifying latent patient subgroups and differential outcomes"]}]}],"canonical_facts":{"dc:contributor":["Heather Janisse, Ph.D.","Jamie Lawler, Ph.D","Elizabeth Neilson, Ph.D."],"dc:creator":["Glownia, Karen"],"dc:date.available":["2025-10-07T07:00:00Z"],"dc:description.abstract":["Fifty percent of children do not receive care for their mental health concerns, while 95% are seen annually within primary care by age 6. Individual, cultural, and systemic barriers limit access to mental health care. Integrating mental health services into primary care has the potential to increase awareness, reduce costs, and decrease stigma. However, integrated primary care often relies on a brief and targeted intervention approach that may not be suitable for all families. Therefore, it is important to examine differential outcomes within this setting. Methods: This study analyzed retrospective data from 3,494 new patient medical records at a large university medical center (Michigan Medicine, University of Michigan) and its six satellite clinics. These clinics were staffed by pediatricians, psychologists, and graduate-level trainees. A structured, multiple-response questionnaire was developed by the center’s senior staff and administered during therapy sessions. Results: A latent class analysis based on demographics, presenting concerns, medical history, and psychosocial risk factors was conducted using Mplus software. The results indicated a four- class solution: Broad Presentation + Psychosocial Risk, High Behavioral Risk, Attention-Related Concerns, and Depression-Anxiety. Covariates were assigned to the model using the auxiliary function to assess group differences. Results indicated that the Broad Presentation + Psychosocial Risk class demonstrated greater symptom improvements than the High Behavioral Risk class, χ²(1) = 6.73, p = .009, and higher session utilization than the Depression-Anxiety class, χ²(1) = 4.17, p = .041. Conclusions: These findings underscore the value of integrated mental health within primary care and suggest that these services may be particularly beneficial for the most at-risk patients with broad symptom presentations and multiple barriers to care
"],"dc:identifier":["https://commons.emich.edu/theses/1315"],"dc:subject":["integrated primary care","latent class analysis","pediatric mental health","treatment outcomes","Clinical Psychology"],"dc:title":["Integrated behavioral health in pediatric primary care: Identifying latent patient subgroups and differential outcomes"],"thesis:degree_discipline":["Psychology"],"thesis:degree_level":["Open Access Dissertation"],"thesis:degree_name":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-24T02:17:53Z"}