Clearly, more research is needed to understand how practices adapt operational and financial strategies for sustaining key program resources, including focused training and technical assistance through the Replicating Effective Programs (REP) program, 42 as well as discussions with state and
local providers and stakeholders on a reimbursement model for care management activities so the
clinics can absorb the costs.43 It is important to point out that the participating
pediatric practices in this clinical trial later hired their own clinicians for on - site services after the trial had ended.