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Expansion and validation of the Parent Acceptance of Pediatric Integrated Care Survey (PAPICS) for the transition to virtual behavioral health care during the COVID-19 pandemic


Andrew Cook ,

University of Michigan Health, Department of Pediatrics, United States, US
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Richard Birnbaum,

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Danielle Haggerty,

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Luke Turnier

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Introduction: Integrated primary care (IPC) models have empirical support for improving access to and quality of behavioral health care and can be effectively implemented in a diverse range of formats1.  Various studies have demonstrated that primary care service providers tend to positively endorse IPC models of pediatric behavioral health care, especially in comparison to traditional, non-integrated care2-3. However, there is a paucity of research evaluating parent perceptions and attitudes towards behavioral health care, especially when delivered in an IPC setting. The present paper describes a survey tool designed to better understand and meet patient care needs. 

Methods and Aims: The Parent Acceptance of Pediatric Integrated Care Survey (PAPICS) was developed by a multidisciplinary panel of integrated care experts at the University of Michigan Medicine to evaluate parent perceptions and acceptance of integrated primary care (IPC) models for treatment of behavioral health problems in children. In response to the COVID-19 pandemic, the PAPICS was expanded to include more items focused on virtual services in IPC and revised to address items with poor factor loadings. Methods include Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to analyze and validate the survey.

Results: The original 35-item PAPICS was distributed to parents pre-pandemic with children under 18 across the United States and was completed by 422 respondents4. Items on this survey largely pertained to face-to-face care within the clinic and an EFA only was conducted to analyze the data. Parents overwhelming favored an IPC model and supported learning skills to help their child. More variability was evidenced for parents’ perceptions of one-on-one talk therapy between their child and the psychologist. Some parents had concerns about stigma and privacy, but agreement was more inconsistent.

After the World Health Organization (WHO) declared COVID-19 a global pandemic, Michigan Medicine’s IPC clinics converted to 100% virtual care. The PAPICS was revised using patient feedback data for applicability to virtual care delivery and was completed by 875 respondents.

Conclusions: Data collection from the revised PAPICS was completed in December 2021. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are presently be conducted and will be reviewed at ICIC22. Results will provide insight into parent perceptions of virtual IPC and allow for comparison to those for face-to-face care.

Implications for applicability/transferability, sustainability, and limitations: The PAPICS survey provides a template for assessing beliefs and preferences of families to provide high-quality, patient-centered behavioral health care in an IPC setting. Though certain items on the survey may not be applicable in some settings, the scale can be adapted as needed.


1. Kolko DJ. The effectiveness of integrated care on pediatric behavioral health: outcomes and opportunities. JAMA Pediatr. 2015;169:894-896. doi:10.1001/jamapediatrics.2015.1428

2. Hine JF, Grennan AQ, Menousek KM, Robertson G, Valleley, RJ, Evans JH. Physician satisfaction with integrated behavioral health in pediatric primary care. J Prim Care Community Health. 2017;8(2):89-93. doi:10.1177/2150131916668115

3. Lancaster B, Cook A, Bruni T, et al. Comparing primary care pediatricians’ perceptions of clinics with and without  integrated  behavioral  health.  Prim Heal Care Res Dev. 2018;20:1-5. doi:10.1017/S1463423618000579

4. Bruni T, Birnbaum R, Turnier L, et al. Notes from the field: results from the parent acceptance of pediatric integrated care survey. J Prim Care Community Health. 2021;12:2150132721990180. doi:10.1177/2150132721990180

How to Cite: Cook A, Birnbaum R, Haggerty D, Turnier L. Expansion and validation of the Parent Acceptance of Pediatric Integrated Care Survey (PAPICS) for the transition to virtual behavioral health care during the COVID-19 pandemic. International Journal of Integrated Care. 2022;22(S3):478. DOI:
Published on 04 Nov 2022.


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