Primary Care Interventions to Caregivers for Children

Describe your topic.: What are the benefits and harms of interventions administered through primary care to caregiver(s) for the benefit of the child to mitigate caregiver behavioral health risk factors or promote children’s cognitive, affective, and behavioral development on child outcomes in two or more condition areas (including long-term outcomes like mental health conditions, substance use, obesity, sexual risk taking, and injury), compared to usual care? Population - Primary caregivers of children 0-17 years old Intervention - Interventions delivered in primary care, analogous to U.S. Preventive Services Task Force recommendations for Sexually Transmitted Infections: Behavioral Counseling, Obesity in Children and Adolescents: Screening (individually or in groups), Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With/Without Cardiovascular Risk Factors: Behavioral Counseling (individually or in groups), or others as appropriate. Comparator - Nothing or referral to specialty care Outcome - Child outcomes in two or more condition areas (including long-term child outcomes of mental health conditions, substance use, obesity, diabetes, sexual risk-taking, and injury), harms Timing - All Setting - Primary care, outpatient

Describe why this topic is important.: Currently, health care does not provide preventive interventions for behavioral health, only early intervention for depression and substance use, and examines each intervention in a condition-specific fashion – interventions that could prevent both depression and substance use are largely ignored. Meanwhile there is voluminous evidence from manualized programs delivered in randomized control trials that behavioral health conditions can be prevented or mitigated care. Unfortunately, this evidence has never been reviewed in such a way that makes it clear how it should inform primary care practice, since it would not necessarily be appropriate to universally implement a specific program. Does it militate toward universal counseling like with Sexually Transmitted Infections: Behavioral Counseling? A screening with intensive individual or group intervention as with Obesity in Children and Adolescents: Screening? Or should it be risk stratified in some way Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With/Without Cardiovascular Risk Factors: Behavioral Counseling?

Tell us why you are suggesting this topic.: This review would review and synthesize the evidence in a way that could drive concrete next steps in primary care transformation. It would immediately make it clear how a group like the USPSTF could recommend cross-cutting prevention and avoids a proliferation of condition-specific intervention. This would hone advocacy efforts and quality improvement to use the best evidence, rather than whatever specific program is available.

Describe what you are doing currently and what you are hoping will change because of a new evidence report.: We are working to enhance primary care's efforts to promote behavioral health, but it is not clear how to the evidence available can be arranged in a way that makes sense for primary care practice reform efforts. This will enable new iterations of advanced primary care models.

How will you or your group use the information from a new evidence report?: All of the stakeholders involved will use it for suggestions to the American Board of Pediatrics, the American Academy of Pediatric's Bright Futures Guidelines, as well as in efforts at the community level to test new models of advanced pediatric primary care.

How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?: The various stakeholder organizations would disseminate it through their memberships and coalitions, and would use it in their future practice improvement work.

Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?: Mental Health America American Academy of Pediatrics American Academy of Family Physicians American Psychological Association American Board of Pediatrics Child and Adolescent Health Measurement Initiative Learning Collaborative on Health Equity and Young Children

Information About You:

If you are you making a suggestion on behalf of an organization, please state the name of the organization: Mental Health America

Please tell us how you heard about the Effective Health Care Program: Working with AHRQ

Effective Health Care Program