SYMPOSIUM 39 PEDIATRIC INTEGRATED BEHAVIORAL HEALTH CARE MODELS: TRANSFORMING VISION INTO PRACTICE Bonnie Zima, MD, MPH, University of California, Los Angeles Health Services Research Center, bzima@mednet.ucla.edu; Lawrence Wissow, MD, MPH, University of Washington, lwissow@uw.edu Objectives: This Symposium is designed to stimulate the discussion on how to apply the transformational model principles to the delivery of pediatric integrated behavioral health care models, identify successful approaches and challenges to implementing key mental health care processes across a con- tinuum of integrated care models, and introduce innovative approaches tailored to pediatric integrated care, such as the family navigator. Methods: Five research studies are presented using a variety of study designs (ie, cross-sectional cohort, longitudinal cohort) and data sources (ie, electronic health care record data, and parent and youth surveys). Results: Findings from these studies span the vision to practice of pediatric integrated behavioral health care models. Priority is placed on implications for the delivery of care to children and youth from predominantly racial/ ethnic minority backgrounds and from transgender- or gender-non- conforming youth. Challenges for implementation include improving the use of systematic behavioral health screening, onsite evidence-based therapies, continuity of mental health care, and sustained linkage to community-based services. Conclusions: Together, these findings suggest that implementation of pedi- atric integrated behavioral health care models in community-based settings serving vulnerable child populations is feasible, acceptable, and promising, but challenges remain. Future research is needed to further refine these care models to improve systematic behavioral health screening, the use of evi- dence-based therapies, continuity of on-site mental health care, and sus- tained linkage to community-based services. EBP, R, MC Sponsored by AACAP’s Community-Based Systems of Care Committee https://doi.org/10.1016/j.jaac.2019.07.869 39.1 TEAM UP FOR CHILDREN: INTEGRATING BEHAVIORAL HEALTH SERVICES INTO LOW- INCOME URBAN PEDIATRIC SETTINGS USING A PRACTICE TRANSFORMATION MODEL Michelle Durham, MD, MPH, Boston Medical Center, michelle.durham@bmc.org; Megan Bair-Merritt, MD, MSC, Mahader Tamene, MSC, Sonia Erlich, MA, Emily Feinberg, ScD, Lisa R. Fortuna, MD, MPH, Anita Morris, MS Objectives: The use of a practice transformation framework is an effective mechanism to guide implementation of integrated behavioral health care across 3 unique health center environments through shared learning to identify and resolve facilitators and barriers. It also supports codification of the implementation process into a model for replication. The 3 key target do- mains of the TEAM UP (Transforming and Expanding Access to Mental Health in Urban Pediatrics) model are: 1) strengthening primary care foundations through organizational readiness, readying the physical and operational health center environment, and building the care team; 2) transforming clinical care through enhanced universal screening, strengthening families of young children, and ensuring access to integrated behavioral health care; and 3) building a learning community to enhance clinical training for the whole care team while providing implementation and sustainability support. Methods: Using the steering committee and quality improvement meetings, each health center assessed their experience and outcomes of new workflows to make improvements. This process engaged multistakeholders from 3 pe- diatric primary care settings in transformation of their care models for behavioral health integration. Results: TEAM UP is a 4-year initiative that seeks to build the capacity of 3 urban community health centers, serving a total of 21,000 children, to deliver high-quality, evidence-based integrated behavioral health care to children and families. TEAM UP partners used a practice transformation framework to identify and resolve barriers to implementation across the 3 unique health center environments through shared learning. Several implementation prior- ities were common across all 3 health centers: 1) organizational readiness and leadership; 2) enhanced universal screening for behavioral health; 3) workforce development; 4) family engagement; 5) focused support during early child- hood; and 6) sustainability. Conclusions: Adopting a practice transformation model that emphasizes collaborative decision making fosters an environment of shared learning and successful implementation of behavioral health integration in pediatrics. MC, CC, R https://doi.org/10.1016/j.jaac.2019.07.870 39.2 IMPLEMENTATION OF COLLABORATIVE CARE FOR PEDIATRIC MENTAL HEALTH PROBLEMS: A SCOPING REVIEW AND EXPERIENCES FROM THE FIELD Andrea Spencer, MD, Boston Medical Center, Andrea.Spencer@bmc.org; Rheanna Platt, MD, MPH Objectives: Several studies have demonstrated the clinical benefits of collab- orative care for a range of child mental health outcomes. However, there is a gap between what is known about efficacious collaborative care interventions and information on their implementation in practice. The goal of this scoping review was to understand how both onsite and offsite collaborative care in- terventions targeting youth have been implemented, sustained, and evaluated. Methods: We systematically searched the literature for interventions target- ing child/youth mental health that involved a mental health specialist either co-located in primary care or working offsite in collaboration with primary care. We included studies that reported on the following implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. These findings are grounded by the authors’ discussion of their experiences with these chal- lenges and rewards in practice as phone consultants and embedded primary care mental health providers. Results: We identified 34 studies describing onsite integrated interventions and 49 studies describing offsite collaborative care interventions. Offsite in- terventions included: in-person specialty care conducted collaboratively with primary care; telepsychiatry; and phone or e-consultation programs to primary care providers. Components facilitating implementation of onsite models included: interprofessional communication and collaboration; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Important facilitators to offsite collaborative care included the identification of an onsite partner or practice champion and defining clear algorithms to stepped care. The challenges included: difficulties with patient engagement in all models; overcoming the mental health/med- ical provider culture divide; and securing funding to sustain programs. Conclusions: Pediatric integrated behavioral health care models vary widely. Target areas for further improvement include patient engagement, reducing the mental health/medical provider cultural divide, and sustainability. CC, MC, R https://doi.org/10.1016/j.jaac.2019.07.871 39.3 MENTAL HEALTH SERVICE USE AND CLINICAL OUTCOMES AMONG CHILDREN SERVED IN 2 CO-LOCATED PEDIATRIC CARE MODELS Bonnie Zima, MD, MPH, University of California, Los Angeles Health Services Research Center, bzima@mednet.ucla.edu; Michael McCreary, MPP, Lily Zhang, MS, Kristen Kenan, MD, Michelle Churchey-Mims, MSW, Hannah Chi, MPH, Madeline Brady, MPH, Anna Mosqueda, MA, Jewel Davies, MA, LCPC, Bennett L. Leventhal, MD S358 www.jaacap.org Journal of the American Academy of Child & Adolescent Psychiatry Volume 58 / Number 10S / October 2019 SYMPOSIA 39.0 — 39.3