Moving Integrated Care for Pediatric Somatic Symptoms into Primary Care: An Innovative Approach

TL;DR

This paper proposes a new model for treating children with unexplained physical symptoms in primary care, aiming to improve access and outcomes.

Contribution

The paper introduces an adapted integrated care model for managing pediatric somatic symptoms in primary care settings.

Findings

Integrated care for somatic symptoms in primary care may increase access and improve child health outcomes.

A co-management model involving primary care providers and behavioral health providers is proposed for mild to moderate symptoms.

The model requires clinician tools and billing practices but could provide holistic care and reduce symptom progression.

Abstract

Integrated behavioral healthcare has addressed common pediatric primary care concerns including anxiety and depression, but is infrequently applied to somatic symptoms (e.g., chronic pain, fatigue, or syncope unattributable to organic causes), which affect one in three youth. Developing an integrated care model for primary care–where most youth with somatic symptoms first present for evaluation and management–may increase access and positively impact child health. This manuscript summarizes the literature surrounding integrated care for pediatric somatic symptoms and proposes an adapted model for primary care. Drawing from the Pediatric Psychosocial Preventative Health model and cognitive-behavioral protocols for somatic symptom management, we propose that youth with mild to moderate symptoms can be effectively co-managed in primary care by a primary care provider delivering psychoeducation and facilitating team coordination, and an embedded behavioral healthcare provider conducting a brief, targeted intervention. This innovative approach leverages shared clinical responsibilities, as well as youth and families’ trust in the primary care setting, to accessibly deliver care for mild-moderate symptoms otherwise unaddressed in current management approaches. Implementation likely requires developing clinician support tools and identifying sustainable billing practices, but may result in accessible, holistic, care that curtails symptom persistence and/or progression.

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