Referrals for externalizing behavior problems are common in pediatric primary care and often occur initially in the referral for ADHD complaints. While optimal intervention for core (e.g., hyperactivity, impulsivity) and peripheral (e.g., aggression, disruptive behavior) externalizing symptoms of pediatric ADHD is multimodal behavioral treatment involving the home and school combined with adjunctive stimulant medication (American Academy of Pediatrics [AAP], 2011; American Psychological Association [APA], 2006), the standard of care in primary care, where most youth are treated, falls short of this recommendation. Integrated care models may offer primary care providers with the resources to meet best practice guidelines by using integrated behavioral health (IBH) services whereby embedded psychologists with specialty training in child behavioral health work closely with families and schools in providing multimodal behavioral treatment within the context of the Family-Centered Medical Home. This study used a repeated measures design at weeks 0, 1, 6, and 12 to evaluate the effectiveness of the Michigan Integrated Behavioral Health ADHD Treatment Algorithm compared with outcomes associated with targeted externalizing behaviors from standard medical care (SMC; i.e., treatment as usual) when controlling for demographic covariates thought to be potential moderators of treatment response (i.e., age, gender, ethnicity, insurance-status). Participants consisted of 73 parents and 63 teachers (N = 136) of children referred for ADHD concerns (N = 73) within two university hospital-affiliated primary care clinics. Results indicated that (1) children receiving the IBH model of care demonstrated lower externalizing ADHD symptoms than SMC at 12 weeks post-treatment (0.36 - 0.43 standardized mean difference); (2) IBH treatment was rated significantly more acceptable than SMC by parents; and (3) IBH treatment yielded high levels of adherence by both parents and teachers. Clinical service reimbursement data between the two models of care are discussed. This study’s results demonstrate how an IBH model of care for externalizing symptoms associated with ADHD referrals may be provided as an alternative to the current standard of care and be delivered within a brief family-centered primary care model, while adhering to evidence-based treatment guidelines.
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