Pediatric Provider Processes for Behavioral Health Screening, Decision Making, and Referral in Sites With Colocated Mental Health Services

ArticleinJournal of developmental and behavioral pediatrics: JDBP 34(9):680-7 · November 2013with15 Reads
DOI: 10.1097/01.DBP.0000437831.04723.6f · Source: PubMed
Abstract
Validated behavioral health (BH) screens are recommended for use at well-child visits. This study aimed to explore how pediatricians experience and use these screens for subsequent care decisions in primary care. The study took place at 4 safety net health centers. Fourteen interviews were conducted with pediatricians who were mandated to use validated BH screens at well-child visits. Interview questions focused on key domains, including clinic BH context, screening processes, assessment of screening scores, and decision making about referral to mental health services. Qualitative analysis used the Framework Approach. A variety of themes emerged: BH screens were well accepted and valued for the way they facilitated discussion of mental health issues. However, screening results were not always used in the way that instrument designers intended. Providers' beliefs about the face validity of the instruments, and their observations about performance of instruments, led to discounting scored results. As a result, clinical decisions were made based on a variety of evidence, including individual item responses, parent or patient concerns, and perceived readiness for treatment. Additionally, providers, although interested in expanding their mental health discussions, perceived a lack of time and of their own skills to be major obstacles in this pursuit. Screens act as important prompts to stimulate discussion of BH problems, but their actual scored results play a variable role in problem identification and treatment decisions. Modifications to scheduling policies, additional provider training, and enhanced collaboration with mental health professionals could support better BH integration in pediatric primary care.
    • "Nevertheless, there is disagreement regarding about one third of all children, mostly due to parental concerns not being confirmed by the CHP. Even when using screening instruments in the identification process, there will be some disagreement between parents and CHPs [19]. Future research should explore the parent-CHP interaction to further elucidate the decision-making process regarding the identification of psychosocial problems in children. "
    [Show abstract] [Hide abstract] ABSTRACT: Background About one third of all parents have concerns about their child’s psychosocial development. Agreement between child health professionals (CHPs) and parents about such concerns may improve treatment adherence and outcomes. This study investigates which child, parenting and/or environmental stressors are associated with (dis)agreement in concerns regarding psychosocial problems in children, in parent-CHP dyads. Methods During routine child health assessments, data were collected from a sample of children aged 14 months to 12 years (n = 3,870). CHPs registered the psychosocial problems that they identified, and parents reported their concerns. Child psychosocial stressors were measured with the ITSEA/CBCL, and the child’s history of psychosocial problems. Environmental stressors referred to stressful family/contextual situations in the past year, and parenting stressors to perceived parenting efficacy. Results The CHPs and parents disagreed on 36.4 % of the children. CHPs based their identification of problems mainly on children’s history of past problem (OR = 5.85, 95 % CI = 4.74–7.22). Parental concerns were most likely in case of an increased ITSEA/CBCL score (OR = 7.69, CI = 5.39–10.97). CHP-parent agreement was more likely in case of a combination of child psychosocial, parenting and environmental stressors (OR = 35.58, CI = 24.11–52.48). Parental concerns not confirmed by the CHP were associated with higher educated parents, originating from an industrialized country, and younger children. The CHP-identified problems not confirmed by parental concerns were associated with older children. Conclusion Agreement between CHPs and parents is associated with a co-occurrence of child, parenting and environmental stressors. Improved agreement between CHP and parents will increase the likelihood of shared decision-making regarding follow-up care and compliance with advice.
    Full-text · Article · Dec 2016
    • "But even though these collaborations and extensions of care beyond the identified patient have long been recognized as important, they receive less emphasis in training programs and frequently are not factored into funding schemes. There are few incentives for mental health clinicians not to fill their agendas with already-ill individuals in need of treatment, and few incentives for non-mental health clinicians to expand their scope of work to include early intervention for mental health prob- lems [17]. One hope for the future is that new structures in health care will be able to improve integration between medical, social, and public health sectors. "
    [Show abstract] [Hide abstract] ABSTRACT: While there is a strong case for primary prevention of mental health problems, relatively little mental health scholarship has been devoted to it in the last decade. Efforts to accelerate prevention scholarship could potentially benefit from strengthening pathways for interdisciplinary research; developing new training and working models for mental health professionals; developing a common language for public, policy, and scientific discussion of prevention; learning how to measure the common outcomes of heterogeneous interventions tailored to diverse communities.
    Full-text · Article · Dec 2015
    • "Participants rate 5 items on a scale of 1 = strongly disagree to 4 = strongly agree, resulting in a range of 5–20, with higher scores indicating greater perceptions of public stigma. This scale has been factor analyzed with adults, revealing one factor as the best solution (Hacker et al., 2013). The SSPPH was adapted in the present study to assess the degree to which the parent believes the public stigmatizes adults who attend parenting classes, as well as the children of adults who attend parenting classes. "
    [Show abstract] [Hide abstract] ABSTRACT: Significant numbers of children have diagnosable mental health problems, but only a small proportion of them receive appropriate services. Stigma has been associated with help-seeking for adult mental health problems and for Caucasian parents. The current study aims to understand factors, including stigma, associated with African American parents' help-seeking behavior related to perceived child behavior problems. Participants were a community sample of African American parents and/or legal guardians of children ages 3-8 years recruited from an urban primary care setting (N = 101). Variables included child behavior, stigma (self, friends/family, and public), object of stigma (parent or child), obstacles for engagement, intention to attend parenting classes, and demographics. Self-stigma was the strongest predictor of help-seeking among African American parents. The impact of self-stigma on parents' ratings of the likelihood of attending parenting classes increased when parents considered a situation in which their child's behavior was concerning to them. Findings support the need to consider parent stigma in the design of care models to ensure that children receive needed preventative and treatment services for behavioral/mental health problems in African American families.
    Full-text · Article · Sep 2015
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