207 - Parent Perspectives on What Integrated Developmental-Behavioral Care Can and Cannot Fix

Publication Number: 3199.207

Anisha Srinivasan, University of California, Davis, School of Medicine, Sacramento, CA, United States; Salvador Lopez, University of California, Davis, School of Medicine, Sacramento, CA, United States; Melanie Venegas, University of California, Davis, School of Medicine, Sacramento, CA, United States; R. Scott Akins, UC Davis, Sacramento, CA, United States; Erik Fernandez y Garcia, ACEs Aware/UC Davis Health, Sacramento, CA, United States; Aubyn C. Stahmer, University of California, Davis, School of Medicine, Sacramento, CA, United States

Background: Publicly insured children experience barriers accessing developmental-behavioral (DB) specialists. While national experts recommend integrated primary care models to improve access and strengthen primary care-specialist collaboration, parent perceptions of integrated DB care are lacking.

Objective: To examine parent experiences in integrated versus usual tertiary DB care using the Consolidated Framework for Implementation Research (CFIR) to inform an enhanced care model.

Design/Methods: We conducted semi-structured qualitative interviews with 22 parents (12 in English, 10 in Spanish) of publicly insured children referred to DB specialists in either an integrated primary care clinic (n=11) or usual tertiary care clinic (n=11) in Northern California from February–September 2025. The CFIR-informed interview guide explored inner setting (i.e., clinic-level factors), outer setting (i.e., healthcare system factors), and innovation (i.e., factors related to integrated care delivery) domains. We analyzed data using the Rapid Assessment Process with investigator triangulation and external audit to enhance trustworthiness.

Results: Participants were primarily mothers (77%), Hispanic (59%), ages 18-55 years(68%); all children were publicly insured. Themes around three CFIR domains revealed differences between care models and shared system challenges [Figure 1]. Both groups experienced fragmented systems and lack of navigation support (outer setting) as well as long wait times for DB appointments (inner setting). However, integrated care parents were more satisfied with their primary care experience, whereas usual care parents noted frustration with communication gaps between primary care clinicians and DB specialists (inner setting). Parents in both groups valued integrated care for its convenience and potential for facilitating primary care-specialist communication. However, some usual care parents expressed concerns about not having access to the multidisciplinary expertise and specialized resources available in tertiary clinics (innovation).

Conclusion(s): While parents value integrated DB care for convenience and inter-clinician communication, they highlighted that specialist integration does not address system-level fragmentation and navigation barriers. Some parents also questioned whether integrated models can replicate the multidisciplinary expertise of tertiary care clinics. These findings can inform development of family-centered care delivery strategies as the DB specialty considers alternative care models to meet patient needs.

Figure 1
PAS_2026 Parent abstract Figure 1.pdfParent-reported factors related to developmental-behavioral (DB) specialty care experiences in integrated versus tertiary (usual) settings, organized by Consolidated Framework for Implementation Research (CFIR) domains.