Integrated behavioral health in pediatric primary care: Identifying latent patient subgroups and differential outcomes

<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>

Name thesis:degree_name

Doctor of Philosophy (PhD)

Level thesis:degree_level

Open Access Dissertation

Discipline thesis:degree_discipline

Psychology

Year dc:date.available

2025

Author dc:creator

• Glownia, Karen

Contributors dc:contributor

• Heather Janisse, Ph.D.
• Jamie Lawler, Ph.D
• Elizabeth Neilson, Ph.D.

• integrated primary care
• latent class analysis
• pediatric mental health
• treatment outcomes
• Clinical Psychology

Repository record dc:identifier

https://commons.emich.edu/theses/1315

OAI identifier oai:identifier

oai:commons.emich.edu:theses-2648