the SKIP for PA Project

About SKIP for PA

The SKIP for PA Study (SKIP stands for Services for Kids in Primary care) is for families of children who are between the ages of 5 and 12 years. We are trying to better understand how we can improve behavioral health care services in primary care practices across Pennsylvania, all of which are members of the Pennsylvania Chapter of the American Academy of Pediatrics (PA AAP).

Project Overview

Funded in January of 2021, the SKIP for PA Study is a randomized, hybrid type 3 effectiveness-implementation trial to support the uptake of a chronic-care model-based program by testing the impact of implementation strategies directed towards the provider care team level (TEAM) or practice leadership level (LEAD). The program we seek to deliver here is called Doctor Office Collaborative Care (DOCC), an evidence-based intervention for the management of child behavior problems and comorbid ADHD. TEAM coaching/consultation strategies will be delivered to care team providers and target provider competency to deliver DOCC. LEAD facilitation strategies will be delivered to practice leadership and target leadership and organizational commitment to DOCC delivery. Neither implementation strategy has been formally evaluated either separately or in combination in any randomized clinical trial in pediatric primary care. Such information is needed to optimize our approaches to promoting the implementation of the CCM in pediatric practice.

The statewide sample includes 24 primary care practices from the medical home program of the Pennsylvania Chapter of the American Academy of Pediatrics. After standard training in the DOCC program, all practices will be randomized to one of four conditions: 1) No TEAM or LEAD (online training and ongoing technical support only); 2) TEAM only; 3) LEAD only, or 4) TEAM+LEAD. Thus, we will provide training in DOCC to all practice staff before initiating our implementation conditions. TEAM and LEAD implementation will be delivered via videoconference (or possibly in person) on a graded schedule. Care teams will deliver DOCC to 25 children who meet a clinical cutoff for modest behavior problems and their caregivers. We will collect practice/provider measures from enrolled practice staff (0, 6, 12, 18, 24 months) and caregivers over several timepoints (0, 3, 6, 12 months) to support all analyses evaluating implementation and treatment outcomes, mediation, and moderation.

By proposing one of the first large pragmatic pediatric trials of a CCM-based EBP to address these aims in response to RFA-MH-18-701 and the NIMH’s Strategic Plan (4.2), this research will advance the implementation science knowledge needed to optimize promising strategies for promoting the delivery and scale-up of DOCC in a pediatric medical home.

Chronic Care Models (CCM) that deliver evidence-based practices (EBP) by multidisciplinary provider teams that include primary care physicians and behavioral health providers have been shown to improve adult and child/teen behavioral health outcomes. However, there remain barriers to the widespread application of these practices (e.g., limited training, resources, and supports).