Integrating medical and behavioural primary health care benefits youth

By Bianca Nogrady
Integrating medical and behavioural health care for children and adolescents in a primary care setting achieves significant gains in youth behavioural health outcomes, a meta-analysis suggests.

US researchers analysed the results of 31 randomised clinical trials that looked at the impact of integrated behavioural health and primary medical care for young people, compared with usual care. They found that while prevention trials had either weak or not statistically significant effects, treatment trials targeting mental health problems such as depression and anxiety and behavioural problems such as disruptive behaviour had far more significant benefits.

‘Effects for treatment trials were stronger than those for prevention trials: the effect size for treatment trials fell in the small to medium range (d = 0.42), with a 66% probability that a randomly selected youth would experience better outcomes after receiving an integrated behavioral health intervention than a randomly selected youth receiving usual care,’ the researchers wrote in their article, published in JAMA Pediatrics. However, substance abuse treatment trials did not reach statistical significance, with only one large trial finding an effect.

Commenting on the study, Professor Jane Burns said the results were compelling in their demonstration that this approach – now considered ‘best practice’ – has a very strong evidence base behind it.

‘For the Australian context, what it means is we now have a very clear blueprint that is consistent with what the National Mental Health Commission report has said,’ commented Professor Burns, CEO of the Young and Well Cooperative Research Centre, Melbourne.

The analysis found the strongest effects with collaborative care interventions.

‘Although a meta-analysis of more than 79 RCTS [randomised clinical trials], including 24,308 patients, supports the clinical effectiveness of collaborative care for adult depression and anxiety relative to usual care, the current meta-analysis is the first to extend these findings to youth and highlights the applicability and benefits of collaborative care across the developmental spectrum,’ the researchers wrote.

Professor Burns cited the Headspace model as an example of how this integration works in practice.

‘You create a one-stop shop which is an integrated system of care; bringing together a primary health care provider – a GP – with a psychologist, psychiatrist and youth worker, with a holistic approach to psychosocial wellbeing of that young person,’ Professor Burns told Medicine Today.

JAMA Pediatr 2015; doi: 10.1001/jamapediatrics.2015.1141.