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Rural and underserved populations endure both limited and differential access to resources, and have increased risks for behavioral health conditions This project evaluated the outcomes of implementing behavioral health services into a rural pediatric primary care practice. Our findings suggest that integrating behavioral health into the primary care setting using the Collaborative Care Model (C°CM) is an effective way to treat depression and anxiety in rural areas.
Mental health disorders are a major public health concern, affecting 21% of the U.S. population (Center for Behavioral Health Statistics and Quality, 2022). Depression is a serious mental health condition that affects approximately 280 million people worldwide, or 3.8% of the population (World Health Organization, 2021), and has been diagnosed in 8% to 14% of primary care patients in the United States (Akincigil & Matthews, 2017). Despite its prevalence, many primary care patients with depression are undetected by primary care providers (PCPs), with some estimates as low as 36.4% (Akincigil & Matthews, 2017). Anxiety disorders are one of the most common mental health disorders and are associated with considerable impairment (Love & Love, 2019). Pediatric mental disorders affect approximately 1 in 5 children, with roughly 50% developing by age 14 years and 75% by age 24 years (Hodgkinson et al., 2017).
Behavioral Health Disparity in Rural and Underserved Populations
Many of the largest disparities in health care are those related to services for rural residents who experience persistent and significant gaps in access to care, including behavioral health services. As of March 31, 2023, nearly 160 million people in the United States (nearly 47.5% of the population) lived in 6,635 mental health professional shortage areas, where there is inadequate access to assessment and treatment of mental health conditions (Health Resources and Services Administration [HRSA], 2023). Approximately, 60.89% of those mental health professional shortage areas were located in rural areas (HRSA, 2023). Those living in rural and underserved areas are disproportionately at risk for substance abuse, suicide, and chronic illness (Selby-Nelson et al., 2018). Outcomes, including treatment effectiveness and quality of life, are worse in rural versus urban settings because of lack of access to medical care, longer distance to care, stigma, and provider shortages (Wong et al., 2019).
Integrated Care/ Collaborative Care Background
Primary care is a...