269 - Bridging the Gap: An Integrated Behavioral Health Approach for Pediatric Wellness in Primary Care

Publication Number: 3258.269

Christina Kratlian, Boston Children's Hospital, Roxbury Crossing, MA, United States; Keneisha Sinclair-McBride, Boston Children's Hospital, Boston, MA, United States; Nicole Heredia, St. John's University, Long Island City, NY, United States; Katherine Barahona Paz, Boston Children's Hospital, cambridge, MA, United States; Joanne E. Cox, Boston Children's Hospital, Boston, MA, United States

Background: A lack of behavioral health (BH) providers has worsened the unmet BH needs of children. Cognitive behavioral therapy (CBT) is an evidence-based standard for non-pharmacological treatment of anxiety and depression. Literature does not describe a model which formally trains pediatric providers to implement CBT skill-building interventions during primary care sessions.

Objective: The primary study aim was to assess the feasibility and acceptability of an interactive CBT skill-building training for pediatric primary care providers focused on adolescents aged 13-19 years old. The secondary aim was to evaluate the intervention effectiveness on patient self-reported symptoms of anxiety and depression.

Design/Methods: The training was developed with Psychology and Social Work experts covering fundamental CBT skills: cognitive restructuring, behavior modification techniques, and coping strategies (Fig 1). Providers demonstrated competency through a written assessment prior to patient sessions and were provided with assessment feedback, session scripts, and billing, safety, and documentation guidance. Patients were recruited at two academic pediatric primary care centers. Patients and providers were matched based on availability and scheduled for four 30-minute virtual skill-building sessions. Patients completed routine BH screeners before and after the sessions. Providers completed Likert scale surveys on comfort and knowledge before and after the sessions. Feedback was obtained from patients and providers (Table 1).

Results: Nine providers' mean CBT skill understanding increased from 3.8 to 4.4 (SD = 0.52; range = 0-5). Mean self-reported post-intervention preparedness increased from 3.5 to 4.0 (SD = 0.53; range = 0-5). Of recruited patients who attended at least one session (8/12, 66%, Table 2), 8 completed the pre-intervention survey and 2 completed the post-intervention survey. Mean Patient Health Questionnaire for Adolescents (PHQ-A) scores decreased from 6.6 (SD = 5.58; range = 0-16) to 2.5 (SD = 2.12; range 1-4) and Generalized Anxiety Disorder - 2 (GAD-2) scores decreased from 1.4 (SD = 2.07; range = 0-5) to 0 (SD = 0; range = 0-0). At three months post-intervention, 2 patients completed the post-intervention survey. Mean PHQ-A scores increased to 4.5 (SD = 6.36; range = 0-9) and GAD-2 scores increased to 1 (SD = 1.41; range = 0-2).

Conclusion(s): This study contributes valuable insights into the feasibility and acceptability of a primary care based-CBT skill building intervention, as well as the positive impacts this may have on adolescents. Next steps include investigating brief intervention options.

Selected Patient-Facing Resources
Excerpts from patient after visit summaries available for providers to send to patients as well as relaxation techniques uploaded to YouTube for free access.

Select Themes from Patient and Provider Open-Ended Feedback


Characteristics of Enrolled Patients