Abstract
The scope of applied behavior analysis has been narrow, and behavior analysts have focused their attention on special populations. Concurrently, there are many children and adolescents outside of these special populations who may benefit from interventions based on behavior analytic practice and who do not access evidence-based treatments. By implementing interventions in the pediatric primary care setting, behavior analysts could expand the scope of practice in the field while improving access to behavioral health treatment for children and adolescents. Behavior analysts have the foundational skills to provide brief, solution-oriented, and problem-focused evidence-based treatment and, with the appropriate training, would be well-suited for work within a fast-paced pediatric primary care setting. There are current health care system barriers, such as licensure concerns, training barriers, and the need for experience functioning as a provider within a multidisciplinary team, that exist for behavior analysts providing services in this setting. Recommendations for how behavior analysts could overcome these barriers and gain competencies necessary for provBehavior Analyst Certification Boardding behavior analytic services in pediatric primary care are discussed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L. (2016). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. JAMA Pediatrics, 169, 929–937. https://doi.org/10.1001/jamapediatrics.2015.1141.
Biel, M. G., Anthony, B. J., Mlynarski, L., Godboy, L., & Beers, L. S. (2017). Collaborative training efforts with pediatric providers in addressing mental health problems in primary care. Academic Psychiatry, 41, 610–616. https://doi.org/10.1007/s40596-017-0709-1.
Blount, A. F., & Miller, B. F. (2009). Addressing the workforce crisis in integrated primary care. Journal of Clinical Psychology in Medical Settings, 16, 113–119. https://doi.org/10.1007/s10880-008-9142.
Briggs-Gowan, M., Horwitz, S., Schwab-Stone, M. E., Leventhal, J. M., & Leaf, P. J. (2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. American Academy of Child and Adolescent Psychiatry, 39, 841–849. https://doi.org/10.1097/00004583-200007000-00012.
Bruni, T. P., & Lancaster, B. M. (2019). Behavior analysis in pediatric primary care: Bringing ABA to scale. Behavior Analysis: Research and Practice, 19, 5–13. https://doi.org/10.1037/bar0000152.
Bruni, T. P., Tennant, K., & Lancaster, B. M. (2019). Habit reversal training (HRT) in a pediatric primary care setting. Behavior Analysis: Research and Practice, 19, 39–46. https://doi.org/10.1037/bar0000155.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of behavior analysis. Journal of Applied Behavior Analysis, 1, 91–97.
Behavior Analyst Certification Board (2020). BACB Certificant Data. Retrieved from: https://www.bacb.com/bacb-certificant-data/.
Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Retrieved from: http://bacb.com/ethics-code/.
Cederna-Meko, C. L., Ellens, R. E. H., Burrell, K. M., Perry, D. S., & Rafiq, F. (2016). An exploration of behavioral health productivity and billing practices within pediatric primary care. Journal of Pediatric Psychology, 41, 1133–1143. https://doi.org/10.1093/jpepsy/jsw063.
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844. https://doi.org/10.1001/archosyc.60.8.837.
Critchfield, T. S., & Reed, D. D. (2017). The fuzzy concept of applied behavior analysis research. The Behavior Analyst, 40, 123–159. https://doi.org/10.1007/s40614-017-0093-x.
Committee on Quality Health Care in America, Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: National Academy Press.
Cooper, S., Valleley, R. J., Polaha, J., Begeny, J., & Evans, J. H. (2006). Running out of time: Physician management of behavioral health concerns in rural pediatric primary care. Pediatrics, 118(1). https://doi.org/10.1542/peds.2005-2612.
Costello, E. J., He, J. P., Sampson, N. A., Kessler, R. C., & Merikangas, K. R. (2014). Services for adolescentswith psychiatric disorders: 12-month data from the national comorbidity survey-adolescent. Psychiatric Services, 65(3), 359–366. https://doi.org/10.1176/appi.ps.201100518.
Epstein, J. N., Kellehner, K. J., Baum, R., Brinkman, W. B., Peugh, J., Gardner, W., et al. (2014). Variability in ADHD care in community-based pediatrics. American Academy of Pediatrics, 134, 1136–1143. https://doi.org/10.1542/peds.2014-1500.
Friman, P. C. (2010a). Come on in, the water is fine: Achieving mainstream relevance through integration with primary medical care. The Behavior Analyst, 33, 19–36. https://doi.org/10.1007/BF03392201.
Friman, P. C. (2010b). Checkered flag for students and professors, yellow flag for the field. Journal of Applied Behavior Analysis, 43, 161–174. https://doi.org/10.1901/jaba.2010.43-161.
Friman, P. C., & Piazza, C. C. (2011). Behavioral pediatrics: Integrating applied behavior analysis with pediatric medicine. In W. W. Fisher, C. C. Piazza, & H. S. Roane (Eds.), Handbook of applied behavior analysis (pp. 433–450). New York: Guilford Press.
Green, C., Storfer-Isser, A., Stein, R. E. K., Garner, A. S., Kerker, B. D., Szilagyi, M., O’Connor, K. G., Hoagwood, K. E., & Horwitz, S. M. (2017). Which Pediatricians Comanage Mental Health Conditions? Academic Pediatrics, 17(5), 479–486. https://doi.org/10.1016/j.acap.2016.10.014.
Hayes, S. C., Rincover, A., & Solnick, J. V. (1980). The technical drift of applied behavior analysis. Journal of Applied Behavior Analysis, 13, 275–285. https://doi.org/10.1901/jaba.1980.13-275.
Hine, J. F., Grennen, A. Q., Menousek, K. M., Robertson, G., Vallely, R. J., & Evans, J. H. (2017). Physician satisfaction with integrated behavioral health in pediatric primary care: Consistency across rural and urban settings. Journal of Primary Care and Community Health, 8, 89–93. https://doi.org/10.1177/2150131916668115.
Hoffman, J. S., & Koocher, G. P. (2018). Strategies of ethical practice in medical settings. Practice Innovations, 3, 43–55. https://doi.org/10.1037/pri0000062.
Hoffses, K. W., Ramirez, L. Y., Berdan, L., Tunick, R., Honakcer, S. M., Meadows, T. J., Shaffer, L., et al. (2016). Topical review: Building competency: Professional skills for pediatric psychologists in integrated primary care settings. Journal of Pediatric Psychology, 41, 1144–1160. https://doi.org/10.1093/jpepsy/jsw066.
Horwitz, S. M., Kelleher, K. J., Stein, R. E. K., Storfer-Isser, A., Youngstrom, E. A., et al. (2007). Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics, 119, e208–e218. https://doi.org/10.1542/peds.2005-1997.
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64, 295–304. https://doi.org/10.1037/1522-3736.3.1.323a.
Kanter, J. W., Caultilli, J. D., Busch, A. M., & Baruch, D. E. (2005). Toward a comprehensive functional analysis of depressive behavior: Five environmental factors and a possible sixth and seventh. The Behavior Analyst Today, 6, 65–81. https://doi.org/10.1037/h0100055.
Kaslow, N. J., Kapoor, S., Dunn, S. E., & Graves, C. C. (2015). Psychologists’ contributions to patient-centered medical homes. Journal of Clinical Psychology in Medical Settings, 22, 199–212. https://doi.org/10.1007/s10880-01509445-4.
Kazak, A. E., Nash, J. M., Hiroto, K., & Kaslow, N. J. (2017). Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges. American Psychologist, 72, 1–12. https://doi.org/10.1037/a0040382.
Kelly, J. E., & Coons, H. L. (2012). Integrated health care and professional psychology: Is the setting right for you? Professional Psychology: Research and Practice, 43, 586–595. https://doi.org/10.1037/a0030090.
Koocher, G. P., & Hoffman, J. S. (2019). Ethical issues applying CBT in medical settings. In R. D. Friedberg & J. K. Paternostro (Eds.), Handbook of cognitive behavioral therapy for medical conditions. https://doi.org/10.1007/978-3-030-21683-2_4.
Knowles, P. (2009). Collaborative communication between psychologists and primary care providers. Journal of Clinical Psychology in Medical Settings, 16(1), 72–76. https://doi.org/10.1007/s10880-009-9151-1.
Lancaster, B., Cook, A., Bruni, T., Sturza, J., Sevecke, J., Ham, H., et al. (2018). Comparing primary care pediatricians’ perceptions of clinics with and without integrated behavioral health. Primary Health Care Research & Development. https://doi.org/10.1017/S1463423618000579.
Laureer, J. A., Marenakos, K. G., Gaffney, K., Ketron, C., & Huncik, K. (2018). Integrating behavioral health in the pediatric medical home. Journal of Child and Adolescent Psychiatric Nursing, 31, 39–42. https://doi.org/10.1111/jcap.12195.
Lavigne, J. V. (2016). Introduction to the special section: Psychology in integrated pediatric primary care. Journal of Pediatric Psychology, 41, 1077–1080. https://doi.org/10.1093/jpepsy/jsw075.
Maragakis, A., & Hatzigeorgiou, M. N. (2018). The transformation of the healthcare system: Integrated primary care and the role of stepped care interventions for behavioral health providers. In A. Maragakis & W. T. O’Donohue (Eds.), Principle-based stepped care and brief psychotherapy for integrated care settings. https://doi.org/10.1007/978-3-319-70539-2_2.
Maragakis, A., Lindeman, S., & Nolan, J. (2018). Evidence based and intensity specific services in the integrated care setting: Ethical considerations for a developing field. Behavior Analysis: Research and Practice, 18, 425–435. https://doi.org/10.1037/bar0000127.
Maragakis, A., Vriesman, M., LaLonde, L., Richling, S., & Lancaster, B. (2019). Quality improvement and behavior analysis: Another name for the rose that smells just as sweet. Journal of Contextual and Behavioral Sciences, 12, 149–153. https://doi.org/10.1016/j.jcbs.2019.02.003.
McDaniel, S. H., Grus, C. L., Cubic, B. A., Hunter, C. L., Kearney, L. K., et al. (2014). Competencies for psychology practice in primary care. The American Psychologist, 69, 409–429. https://doi.org/10.1037/a0036072.
Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the national comorbidity survey–adolescent supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980–989. https://doi.org/10.1016/j.jaac.2010.05.2017.
Meadows, T., Valleley, R., Haack, M. K., Thorson, R., & Evans, J. (2011). Physician “costs” in providing behavioral health in primary care. Clinical Pediatrics, 50(5), 447–455. https://doi.org/10.1177/0009922810390676.
O’Donohue, W., Snipes, C., & Maragakis, A. (2014). Increasing the productivity of the clinical psychologist: A neglected archimedean pivot? Professional Psychology: Research and Practice, 45(5), 357–367. https://doi.org/10.1037/a0037741.
Perou, R., Bitsko, R. H., Blumberg, S. J., et al. (2013). Centers for Disease Control and Prevention (CDC). Mental health surveillance among children—United States, 2005–2011. MMWR Suppl, 62, 1–35. Retrieved from: https://stacks.cdc.gov/view/cdc/13598.
Polaha, J., Dalton, W. T., & Allen, S. (2011). The prevalence of emotional and behavior problems in pediatric primary care serving rural children. Journal of Pediatric Psychology, 36, 652–660. https://doi.org/10.1093/jpepsy/jsq116.
Riley, A. R., & Freeman, K. A. (2019). Impacting pediatric primary care: Opportunities and challenges for behavioral research in a shifting healthcare landscape. Behavior Analysis: Research and Practice, 19, 23–38. https://doi.org/10.1037/bar0000114.
Rozensky, R. (2014). Implications of the patient protection and affordable care act: Preparing the professional psychology workforce for primary care. Professional Psychology: Research and Practice, 45, 200–211. https://doi.org/10.1037/a0036550.
Stancin, T., & Perrin, E. C. (2014). Psychologists and pediatricians: Opportunities for collaboration in primary care. American Psychologist, 69, 332–342. https://doi.org/10.1037/a0036046.
Sterling, S., Kline-Simon, A. H., Weisner, C., Jones, A., & Satre, D. D. (2018). Pediatrician and behavioral clinician-delivered screening, brief-intervention and referral to treatment: Substance use and depression outcomes. Journal of Adolescent Health, 62, 390–396. https://doi.org/10.1016/j.adohealth.2017.10.016.
Sharp, L., Pantell, R. H., Murphy, Li. O., & Lewis, C. C. (1992). Psychosocial problems during child health supervision visits: Eliciting, then what? Pediatrics, 89(4), 619–623.
Talmi, A., Muther, E. F., Margolis, K., Buchholz, M., Asherin, R., & Bunik, M. (2016). The scope of behavioral health integration in pediatric primary care setting. Journal of Pediatric Psychology, 41, 1120–1132. https://doi.org/10.1093/jpepsy/jsw065.
Weisz, J. R., Kuppens, S., Eckshtain, D., Ugeeto, A. M., Hawley, K. M., & Jenson-Doss, A. (2013). JAMA Psychiatry, 70, 750–761. https://doi.org/10.1001/jamapsychiatry.2013.1176.
Wildman, B. G., & Langkamp, D. L. (2012). Impact of location and availability of behavioral health services for children. Journal of Psychology in Medical Settings, 19, 393–400. https://doi.org/10.1007/s10880-012-9324-1.
World Health Organization. (2015). International statistical classification of diseases and related health problems (10th revision, 5th ed. 2016). World Health Organization. Retrieved from: https://apps.who.int/iris/handle/10665/246208.
Wu, P., Hoven, C., Bird, H., Moore, R., Cohen, P., Alegria, M., Dulcan, M. K., Goodman, Ss., Horwitz, S., Lichtman, J., Narrow, W. E., Rae, D., Reiger, D. A., &Roper, M. T. (1999). Depressive and disruptive disorders and mental health utilization in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 38(9), 1081–1089. https://doi.org/10.1097/00004583-199909000-00010.
Zablotsky, B., Black, L. I., & Blumberg, S. J. (2017). Estimated prevalence of children with diagnosed developmental disabilities in the United States, 2014-2016. NCHS Data Brief, 291, 1–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
LaLonde, L., Maragakis, A., Bruni, T., Lancaster, B. (2021). Suitability of Behavior Analysis in Pediatric Primary Care. In: Maragakis, A., Drossel, C., Waltz, T.J. (eds) Applications of Behavior Analysis in Healthcare and Beyond. Springer, Cham. https://doi.org/10.1007/978-3-030-57969-2_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-57969-2_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-57968-5
Online ISBN: 978-3-030-57969-2
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)