Safety-net Leadership Perspectives on Collaborative Care for Children With Developmental Disabilities.

Abstract

Objective: To identify key barriers and facilitators to designing and implementing collaborative care (CC) for children with developmental disabilities (DD) in safety-net primary care.

Methods: This pre-implementation qualitative study involved semi-structured interviews with safety-net primary care leaders. Using purposive and respondent-driven sampling, interviews were conducted with 16 leaders across 9 safety-net organizations in Northern California between August 2024 and January 2025. Key Consolidated Framework for Implementation Research (CFIR) constructs guided data collection. Data were analyzed using the Rapid Assessment Process and validated through structured member checking.

Results: Leaders from 8 of 9 organizations reported existing integrated behavioral health programs staffed by mental health counselors and/or psychiatrists, but nearly all noted that these programs did not address the specific needs of children with DD. When asked about developing a CC intervention for this population, leaders identified implementation barriers and facilitators that mapped to CFIR inner and outer setting domains. Four themes were distilled: inner setting barriers (space and cost), inner setting facilitators (perceived clinical need among leadership), outer setting barriers (restrictive Medicaid reimbursement policies and limited performance measurement pressure), and outer setting facilitators (alternative financing mechanisms).

Conclusion: Safety-net leaders indicate a clinical need for CC models specifically for children with DD, but implementation success will depend on addressing space, financing, and policy barriers through targeted implementation strategies.