Primary Health Care Quality in a National Sample of Children and Youth with Mental Health Impairment

Department of Health Services, University of Washington, Seattle, WA 98195-4920, USA.
Journal of developmental and behavioral pediatrics: JDBP (Impact Factor: 2.13). 11/2010; 31(9):694-704. DOI: 10.1097/DBP.0b013e3181f17b09
Source: PubMed


To examine the general pediatric health care quality experiences of children and youth with mental health impairment.
We conducted a cross-sectional analysis of 2006 Medical Expenditures Panel Survey data for children and youth aged 5 to 17 years (n = 7263). Mental health impairment was defined using the recommended cut-point (score ≥ 16) on the parent version of the Columbia Impairment Scale. Health care quality was measured with the Consumer Assessment of Healthcare Providers and Systems including parent ratings in 3 domains: provider communication, getting needed care, and getting care quickly. Logistic regression was used to test associations between mental health impairment and dichotomized Consumer Assessment of Healthcare Providers and Systems measures (poor vs good quality) adjusted for demographic characteristics, health insurance, and socioeconomic status. Analysis was conducted with Stata, Version 10.1 SE, and all estimates accounted for the Medical Expenditures Panel Survey complex sampling design.
In multivariable analysis, health care experiences of children with mental health impairment (versus those without) were consistently rated less favorably by parents, with greater odds of inferior quality of care ratings in all domains: getting needed care (odds ratio [OR] = 2.35), getting care quickly (OR = 1.41), physician communication (OR = 1.72), and overall health care quality (OR = 1.63).
Further research is needed to identify specific aspects of care that families find problematic in relation to the organization and delivery of care within each quality domain. Interventions are needed to improve service systems for children and youth with mental health impairment, especially to support access to needed care.

4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study examined how chronic experiences of peer victimization throughout childhood relate to mental and physical health outcomes in adolescence. Children were tested in a laboratory playroom at the age of 5 years. They completed questionnaires at time 2, between the ages of 10 and 18 years, and a telephone interview at time 3, between the ages of 12 and 20 years. A total of 70 youth participated at all three time periods. Chronic victims were defined as having high levels of peer victimization at all three time points. Youth who were chronically victimized reported experiencing significantly more mental and physical health problems than youth categorized as desisters or nonvictims. Also, for girls only, chronic victims reported more specific health problems (headaches, sleep problems) than did nonchronic victims. The present findings may assist health professionals in assessing and treating physical and mental health problems that appear to be related to peer victimization.
    No preview · Article · Jun 2011 · Journal of Pediatric Psychology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the construct validity of the Behavioral Health Checklist (BHCL) for children aged from 4 to 12 years from diverse backgrounds. The parents of 4-12-year-old children completed the BHCL in urban and suburban primary care practices affiliated with a tertiary-care children's hospital. Across practices, 1,702 were eligible and 1,406 (82.6%) provided consent. Children of participating parents were primarily non-Hispanic black/African American and white/Caucasian from low- to middle-income groups. Confirmatory factor analyses examined model fit for the total sample and subsamples defined by demographic characteristics. The findings supported the hypothesized 3-factor structure: Internalizing Problems, Externalizing Problems, and Inattention/Hyperactivity. The model demonstrated adequate to good fit across age-groups, gender, races, income groups, and suburban versus urban practices. The findings provide strong evidence of the construct validity, developmental appropriateness, and cultural sensitivity of the BHCL when used for screening in primary care.
    Full-text · Article · Aug 2013 · Journal of Pediatric Psychology
  • [Show abstract] [Hide abstract]
    ABSTRACT: To understand how primary care providers (PCPs) perceive barriers to adolescent depression care to inform strategies to increase treatment engagement. We conducted semistructured interviews with 15 PCPs recruited from community pediatric offices with access to integrated behavioral health services (ie, low system-level barriers to care) who participated in a larger study on treating adolescent depression. Interviews addressed PCP perceptions of barriers to adolescents' uptake of care for depression. Interviews were audiorecorded, transcribed, and coded for key themes. Although PCPs mentioned several adolescent barriers to care, they thought parents played a critical role in assisting adolescents in accessing mental health services. Important aspects of the parental role in accessing treatment included transportation, financial support, and social support. PCPs perceived that parental unwillingness to accept the depression diagnosis, family dysfunction, and trauma were common barriers. PCPs contrasted this with examples of good family support they believed would enable adolescents to attend follow-up appointments and have a "life coach" at home to help monitor for side effects and watch for increased suicidality when starting antidepressants. In this PCP population, which had enhanced access to mental health specialists, PCPs primarily reported attitudinal barriers to adolescent depression treatment, focusing mainly on perceived parent barriers. The results of these qualitative interviews provide a framework for understanding PCP perceptions of parental barriers to care, identifying that addressing complex parental barriers to care may be important for future interventions. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · The Journal of pediatrics