Preventive Behavioral Health Programs in Primary Care: A Systematic Review

Abstract

CONTEXT: Early childhood is a critical period for socioemotional development. Primary care is a promising setting for behavioral health programs. OBJECTIVES: To identify gaps in the literature on effectiveness and readiness for scale-up of behavioral health programs in primary care. DATA SOURCES: PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase, Evidence-Based Medicine Reviews, and Scopus databases were searched for articles published in English in the past 15 years. Search terms included terms to describe intervention content, setting, target population, and names of specific programs known to fit inclusion criteria. STUDY SELECTION: Inclusion criteria were: (1) enrolled children 0 to 5 years old, (2) primary care setting, (3) measured parenting or child behavior outcomes, and (4) clinical trial, quasi-experimental trial, pilot study, or pre-post design. DATA EXTRACTION: Data were abstracted from 44 studies. The rigor of individual studies and evidence base as a whole were compared with the Society of Prevention Research’s standards for efficacy, effectiveness, and scale-up research. RESULTS: Gaps in the literature include: study findings do not always support hypotheses about interventions’ mechanisms, trust in primary care as a mediator has not been sufficiently studied, it is unclear to which target populations study findings can be applied, parent participation remains an important challenge, and the long-term impact requires further evaluation. LIMITATIONS: Potential limitations include publication bias, selective reporting within studies, and an incomplete search. CONCLUSIONS: Targeting gaps in the literature could enhance understanding of the efficacy, effectiveness, and readiness for scale-up of these programs.