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Implementation of Off-Site Integrated Care for Children: A Scoping Review.
Spencer, Andrea E. MD *; Platt, Rheanna E. MD, MPH *; Bettencourt, Amie F. PhD; Serhal, Eva MBA; Burkey, Matthew D. MD, PhD, MPH; Sikov, Jennifer BA; Vidal, Carol MD, MPH; Stratton, Julia MD; Polk, Sarah MD, ScM; Jain, Sonal DO; Wissow, Lawrence MD, MPH
[Review] Harvard Review of Psychiatry. 27(6):342-353, November/December 2019.

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Background: As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care.

Methods: We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability).

Results: We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models.

Conclusions: Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.