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Core Divisions


Our Model

Many mental health services currently draw on the chronic care model developed by Wagner and colleagues (Wagner 1996).  This method centers on five key points: using evidence-based treatments, improving a practice’s ability to implement those treatments, supporting patients as they try to manage their own conditions and employing information systems to track how well patients’ progress.

While this model has shown success with some groups of patients and certain diseases, it is not ideally suited to meet the needs of children with mental health concerns.  One major concern is that the chronic care model is designed to support the treatment of a single, diagnosable disease with a specified therapy (Asarnow et al. 2005).  This is rare in pediatric primary care settings, where providers often confront broader categories of concerns, like anger or anxiety, in their young patients.

We adapt the chronic care model to integrate common factors and treatment elements that could apply across a range of mental health diagnoses.

Theory

The idea is that certain common factors—characteristics of patients and providers, their interactions, and provider techniques—can impact a patient’s outcome, regardless of their diagnosis.  Certain treatment elements—like gradually exposing a child to a fearful situation to help manage anxiety—can prove useful across a broader range of specific anxiety disorders.

Practice

Our model has primary care providers seeking to identify emotional and behavioral impairments, and problems salient to families, rather than attempting to make specific diagnoses.  The pediatrician uses these more general techniques to build rapport with the child and their family and work together to develop a treatment plan.  With support from specialty consultants, familes may be able to follow up with the pediatrician to assess how the plan is going; children with more severe impairments may need specialist referrals.

Assessment

The Center’s research projects analyze an array of questions about the model and its implementation.  These include what factors affect how children over different ages feel about their doctors, how our model impacts clinician workload and more.

Reference:
Wagner, E. H., Austin, B. T., & Von Korff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly, 74(4), 511–544.

Asarnow JR, Jaycox LH, Duan N, LaBorde AP, Rea MM, Murray P, et al. Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: A randomized controlled trial. Journal of the American Medical Association. 2005 Jan 19;293(3):311-9.

Evidence Based Services Committee, Child and Adolescent Mental Health Division, Hawaii Department of Health. Summary of effective interventions for youth with behavioral and emotional needs. 2004.