Integrative Health Care in Pediatric and Family Health-Care Settings
October 7, 2014
Editor’s Note: This week’s blog has been written by guest author Richard Abidin, EdD. Dr. Abidin is a Professor Emeritus of Clinical and School Psychology in the Curry School of Education at the University of Virginia, where he served as Director of the Clinical Psychology program. He is the author of the Parenting Stress Index™, Fourth Edition, an inventory designed to evaluate stress in the parent-child system.

Integrative health care is a system in which quality health-care services are provided to individuals, families, and communities. One hoped-for side effect is that the cost of health care will be reduced or contained by the efficient use of resources.

I would like to briefly describe, to stimulate the thinking of others, one example of how integrative health care was done some 40 years ago.

The pediatric group practice that was caring for my own children asked me to come to their practice to discuss how to identify children who should be referred for either mental health or special education services. That request was the catalyst for creating a system of integrated psychological and medical services, and it also was the beginning of what would become the first edition of the Parenting Stress Index (PSI).

The practice provided me with a small exam room that served as my office two days per week. I was given access to the medical records of those families whom I saw or was consulted on, and I placed a copy of my notes and homework prescriptions in the patients’ files. I used the practice’s billing and support personnel, and the practice received 30% of my billings as an overhead charge.

How did the system work? I received referrals from the pediatricians or sometimes from the families themselves. The pediatricians’ referrals would come via two sources: the pediatricians’ interactions with the child or parent or the results of the Parenting Stress Index screening that I developed (and later published with PAR). I typically had a 30- to 40-minute session starting on the hour, followed by 5 minutes for notes and 15 minutes for consulting with the pediatricians or receiving a new referral.

With this system, we found that almost 100% of patients referred for mental health or special education services followed through with appointments, versus the typical referral follow-through rate of 50% or less. The high rate of follow through on the referrals was due to the pediatrician walking the parent to my office and introducing me. The parent and I would speak for a few minutes about their concerns and then set up an appointment. Eventually, the results of the PSI screening became the major generator of referrals by the pediatricians.

Over the years, the Parenting Stress Index has been refined to meet the changing needs of children, parents, and the clinicians who support them and today is in its fourth edition.