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Hoskote AR, Rolin D, Rew L, Johnson KE. Effects of COVID-19 on School Nurse Mental Health Intervention Practices. J Sch Nurs 2023:10598405231172758. [PMID: 37158076 PMCID: PMC10183332 DOI: 10.1177/10598405231172758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Mental health issues have been exacerbated by COVID-19; therefore we examined how the school nurses' role in addressing mental health changed during the pandemic. We administered a nationwide survey in 2021, guided by the Framework for the 21st Century School Nurse, and analyzed self-reported changes in mental health interventions by school nurses. Most mental health practice changes after the start of the pandemic occurred in the care coordination (52.8%) and community/public health (45.8%) principles. An overall decrease in students visiting the school nurse's office (39.4%) was seen, yet the frequency of students visiting with mental health concerns had increased (49.7%). Open-ended responses indicated that school nurse roles changed due to COVID-19 protocols, including decreased access to students and changes in mental health resources. These insights into the role of school nurses in addressing student mental health during public health disasters have important implications for future disaster preparedness efforts.
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Affiliation(s)
- Ashwini R Hoskote
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Donna Rolin
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Lynn Rew
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Karen E Johnson
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
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2
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Stefko JM, Stolfi A, Pascoe JM. Screening for Children's Chronic Health Conditions and Their Strengths and Difficulties in Primary Care. J Dev Behav Pediatr 2022; 43:e1-e8. [PMID: 33990509 DOI: 10.1097/dbp.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study explores parents' perceptions of their child's health status and their strengths and difficulties using 2 validated instruments in primary care settings. METHODS This cross-sectional study was conducted between February 2018 and October 2019. Parents of children aged 2 to 18 years completed the Children with Special Health Care Needs (CSHCN) screener and the Strengths and Difficulties Questionnaire (SDQ) as well as demographics. The CSHCN uses 5 questions to identify children with chronic health conditions. Three subgroups were created: children with no chronic health condition (NCHC), chronic health condition with no functional limitations (NFLs), and chronic health condition with functional limitations (FLs). Higher SDQ scores indicate higher degrees of a factor. Associations between CSHCN subgroups and SDQ scores, controlling for demographics, were analyzed with multiple linear regressions. RESULTS In total, 970 parents' surveys (87.9% completed surveys) were included in this analysis: 76.4% of respondents were married, 56.4% had an annual household income ≥$50,000%, and 61.7% were employed full time; 53.0% of the index children were males, 72.1% were White, and 61.4% had private insurance. Mean (SD) total SDQ scores across the 3 CSHCN subgroups were significantly different (NCHC, 7.7 [4.8]; NFL, 12.6 [6.6]; FL, 16.0 [6.7], p < 0.001). The mean SDQ prosocial scores were higher in the NCHC subgroup (p < 0.001), as hypothesized. The SDQ means for the 3 subgroups remained significantly different after controlling for demographics. CONCLUSION Children with FLs had significantly higher total SDQ scores than children in the other 2 subgroups, which may aid clinicians in the early identification of children who would benefit from behavioral health resources.
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Affiliation(s)
- Jordan M Stefko
- Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Adrienne Stolfi
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - John M Pascoe
- Community Research, Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH
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Lynch FL, Dickerson JF, Rozenman MS, Gonzalez A, Schwartz KTG, Porta G, O’Keeffe-Rosetti M, Brent D, Weersing VR. Cost-effectiveness of Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care. JAMA Netw Open 2021; 4:e211778. [PMID: 33720373 PMCID: PMC7961309 DOI: 10.1001/jamanetworkopen.2021.1778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Youth anxiety and depression are common and undertreated. Pediatric transdiagnostic interventions for anxiety and/or depression may be associated with improved access to treatment among youths. OBJECTIVE To evaluate the cost-effectiveness of a pediatric transdiagnostic brief behavioral therapy (BBT) program for anxiety and/or depression compared with assisted referral to community outpatient mental health care (ARC). DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, an incremental cost-effectiveness analysis was performed from the societal perspective using data from a randomized clinical trial of youths with full or probable diagnoses of anxiety or depression who were recruited from pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania. The trial was conducted from October 6, 2010, through December 5, 2014, and this analysis was performed from January 1, 2019, through October 20, 2020. INTERVENTIONS In the randomized clinical trial, youths were randomized to BBT (n = 95) or ARC (n = 90). The BBT program consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level therapists. Families randomized to ARC received personalized referrals to mental health care and telephone calls to support access to care. MAIN OUTCOMES AND MEASURES Anxiety-free days, depression-free days, quality-adjusted life-years (QALYs), and costs based on incremental cost-effectiveness ratios from intake through 32-week follow-up. A cost-effectiveness acceptability curve for QALYs was used to assess the probability that BBT was cost-effective compared with ARC over a range of amounts that a decision-maker might be willing to pay for an additional outcome. RESULTS Enrolled patients included 185 youths (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] White; and 38 [20.7%] Hispanic). Youths who received BBT experienced significantly more anxiety-free days (difference, 28.63 days; 95% CI, 5.86-50.71 days; P = .01) and QALYs (difference, 0.026; 95% CI, 0.009-0.046; P = .007) compared with youths who received ARC. Youths who received BBT experienced more depression-free days than did youths who received ARC (difference, 10.52 days; 95% CI, -4.50 to 25.76 days; P = .18), but the difference was not statistically significant. The mean incremental cost-effectiveness ratio was -$41 414 per QALY (95% CI, -$220 601 to $11 468). The cost-effectiveness acceptability curve analysis indicated that, at a recommended willingness-to-pay threshold of $50 000 per QALY, the probability that BBT would be cost-effective compared with ARC at 32 weeks was 95.6%. CONCLUSIONS AND RELEVANCE In this economic evaluation, BBT in primary care was significantly associated with better outcomes and a greater probability of cost-effectiveness at 32 weeks compared with ARC. The findings suggest that transdiagnostic BBT may be associated with improved youth anxiety and functioning at a reasonable cost.
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Affiliation(s)
- Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Araceli Gonzalez
- Department of Psychology, California State University of Long Beach, Long Beach
| | | | - Giovanna Porta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - V. Robin Weersing
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California San Diego, San Diego
- Department of Psychology, San Diego State University, San Diego, California
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Abstract
OBJECTIVE To assess pediatric primary care providers' (PCPs) knowledge, perceived barriers, and needs related to child and adolescent anxiety in their practice. METHODS Primary care providers licensed and practicing in the state of Colorado were invited to complete an online knowledge and needs assessment. The survey queried their knowledge of pediatric anxiety, experience in assessing and treating anxiety, perceived barriers in their practice setting to adequately addressing youth anxiety, and interest in additional training on this topic. RESULTS Survey completers included 115 PCPs (51 medical doctors and 64 nurses/nurse practitioners). PCPs had been practicing with their current medical license with pediatric patients for an average of 14 years (SD = 10.45), and 70% reported that they regularly discuss anxiety with patients and parents. Although PCPs had a basic knowledge of youth anxiety, there appeared to be significant gaps in PCP knowledge. Specifically, knowledge gaps included evidence-based assessment and treatment, how to differentiate between developmentally appropriate, transient episodes of anxiety versus anxiety disorders, and where and how to refer youth for specialty services. Nearly all (80%) PCPs indicated that they would be "extremely interested" in additional training in pediatric anxiety, particularly if it occurred in their organizational setting, at a nearby community setting, or online. CONCLUSION Primary care providers reported that a substantial proportion of the patients they see struggle with anxiety. PCPs also reported a growing need for training in how to assess, treat, and refer anxious youth. This needs assessment supports a need for the development of easily accessible training and resources for PCPs to better support their pediatric patients.
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Espinet SD, Gotovac S, Knight S, Wissow L, Zwarenstein M, Lingard L, Steele M. Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:319-329. [PMID: 31813273 PMCID: PMC7265617 DOI: 10.1177/0706743719890161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
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Affiliation(s)
- Stacey D Espinet
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Sandra Gotovac
- Division of Child and Adolescent Psychiatry, London Health Sciences Center, London, Ontario, Canada
| | - Sommer Knight
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Larry Wissow
- School of Medicine, University of Washington, DC, USA
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, The University of Western Ontario, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Health Sciences Addition, The University of Western Ontario, London, Ontario, Canada
| | - Margaret Steele
- Discipline of Psychiatry, Faculty of Medicine, Memorial University of Newfoundland, Saint John's, Newfoundland, Canada
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McGuier EA, Kolko DJ, Ramsook KA, Huh AS, Berkout OV, Campo JV. Effects of Primary Care Provider Characteristics on Changes in Behavioral Health Delivery During a Collaborative Care Trial. Acad Pediatr 2020; 20:399-404. [PMID: 31760174 PMCID: PMC7138708 DOI: 10.1016/j.acap.2019.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Pediatric primary care providers (PCPs) are increasingly expected to deliver behavioral health (BH) services, yet PCP characteristics that facilitate or hinder BH service delivery are poorly understood. This study examined how PCP characteristics and collaborative care participation influenced changes in BH-related effort and competency over time. METHODS Pediatric PCPs (N = 74) participating in a cluster randomized trial (8 practices) of a collaborative care intervention for disruptive behavior problems completed self-report measures at 0, 6, 12, and 18 months. Latent growth curve models tested the impact of PCP characteristics (ie, age, gender, negative BH beliefs, BH burden, BH competency) on changes in identification/treatment of disruptive behavior disorders and competency over the course of the trial. RESULTS Participation in collaborative care was associated with increases in identification/treatment, with no evidence that PCP characteristics moderated changes in identification/treatment. For competency, however, older PCPs (>50 years) in collaborative care exhibited steep increases over time, while older PCPs in the comparison condition exhibited steep decreases, suggesting differential benefits of collaborative care participation by PCP age. In both conditions, PCPs with more negative BH beliefs reported less identification/treatment over time. Baseline competency was positively associated with identification/treatment and associations weakened over time. Gender and perceived burden had little impact. CONCLUSIONS PCP characteristics are associated with changes in PCPs' BH-related effort and competency over time. Participation in a collaborative care model appears to be especially beneficial for older PCPs. Implementation of collaborative care can promote growth in BH-related effort and competency for PCPs.
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Affiliation(s)
- Elizabeth A. McGuier
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J. Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - K. Ashana Ramsook
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
| | | | - Olga V. Berkout
- Department of Psychology and Sociology, Texas A&M University Corpus Christi, Corpus Christi, TX, USA
| | - John V. Campo
- West Virginia University and the Rockefeller Neuroscience Institute, Morgantown, WV, USA
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Eklund K, DeMarchena SL, Rossen E, Izumi JT, Vaillancourt K, Rader Kelly S. Examining the role of school psychologists as providers of mental and behavioral health services. PSYCHOLOGY IN THE SCHOOLS 2019. [DOI: 10.1002/pits.22323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Katie Eklund
- Department of Educational PsychologyUniversity of Wisconsin‐Madison Madison Wisconsin
| | - Sarah L. DeMarchena
- Department of Education, School, and Counseling PsychologyUniversity of Missouri Columbia Missouri
| | - Eric Rossen
- National Association of School Psychologists Bethesda Maryland
| | - Jared T. Izumi
- Department of Education, School, and Counseling PsychologyUniversity of Missouri Columbia Missouri
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Sharifi V, Shahrivar Z, Zarafshan H, Ashkezary SB, Stuart E, Mojtabai R, Wissow L. Collaborative care for child and youth mental health problems in a middle-income country: study protocol for a randomized controlled trial training general practitioners. Trials 2019; 20:405. [PMID: 31287011 PMCID: PMC6615304 DOI: 10.1186/s13063-019-3467-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Child and youth mental health problems are leading causes of disability and particular problems in low- and middle-income countries where populations are young and child mental health services are in short supply. Collaborative care models that support primary care providers' efforts to detect and treat child mental health problems offer one way to address this need. However, collaborative care for child mental health can be more complex than collaboration for adults for a number of reasons, including two-generational aspects of care, high degrees of co-morbidity, and variations in presentation across developmental stages. METHODS The study takes advantage of an existing collaborative care network in Tehran, Iran, in which general practitioners are supported by community mental health centers to care for adult mental health problems. At present, those practitioners are asked to refer children with mental health problems to the collaborating centers rather than treating them themselves. We are conducting a cluster randomized trial in which practitioners in the network will be randomized to receive training in child/youth mental health treatment or a booster training on recognition and referral. Children/youth aged 5-15 years making visits to the practitioners will be screened using the Strengths and Difficulties Questionnaire; those found positive will be followed for six months to compare outcomes between those treated by trained or control practitioners. DISCUSSION If the trial demonstrates superior outcomes among children treated by trained practitioners, it will support the feasibility of expanding collaborative care networks to include children. TRIAL REGISTRATION ClinicalTrials.gov, NCT03144739 . Registered on 8 May 2017.
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Affiliation(s)
- Vandad Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Shahrivar
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Zarafshan
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Elizabeth Stuart
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence Wissow
- Division of Child and Adolescent Psychiatry, School of Medicine, University of Washington, 4800 Sand Point Way NE, M/S OA.5.154, PO Box 5371, Seattle, WA 98145-5005 USA
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Koning NR, Büchner FL, Verbiest MEA, Vermeiren RRJM, Numans ME, Crone MR. Factors associated with the identification of child mental health problems in primary care-a systematic review. Eur J Gen Pract 2019; 25:116-127. [PMID: 31246106 PMCID: PMC6713156 DOI: 10.1080/13814788.2019.1623199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Although common and often with long-lasting effects, child mental health problems (MHPs) are still under-recognized and under-treated. A better understanding of the factors associated with the identification of MHPs in primary care may improve the recognition of MHPs. Objectives: To review studies on factors associated with the identification of child MHPs in primary care. Methods: Six leading databases were systematically searched until 1 October 2018. Two independent researchers selected articles and extracted data on study characteristics and factors associated with MHP identification. Inclusion criteria were the investigation of factors associated with MHP identification by primary care professionals (PCPs) in children aged 0–18 years. Results: Of the 6215 articles identified, 26 were included. Prevalence rates of PCP-identified MHPs varied between 7 and 30%. PCPs identified 26–60% of children with an increased risk of MHPs as indicated by MHP assessment tools, but associated factors were investigated in relatively few studies. MHPs were more often identified in children with a family composition other than married parents, with worse mental health symptoms, prior MHPs, among boys in elementary school, when contact with PCPs was related to parental psychosocial concerns or routine health check-ups, when PCPs were recently trained in MHPs or when PCPs felt less burdened treating MHPs. Conclusion: MHP identification varied substantially between studies and PCPs and was related to several child, family and practice factors. Future studies should systematically investigate factors associated with MHP identification by PCPs and specifically in children with an increased risk of MHPs according to mental health assessment tools.
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Affiliation(s)
- Nynke R Koning
- a Department of Public Health and Primary Care, Leiden University Medical Centre , Leiden , The Netherlands
| | - Frederike L Büchner
- a Department of Public Health and Primary Care, Leiden University Medical Centre , Leiden , The Netherlands
| | - Marjolein E A Verbiest
- b Centre for Longitudinal Research-He Ara ki Mua, The University of Auckland , Auckland , New Zealand.,c National Institute for Health Innovation, The University of Auckland , Auckland , New Zealand
| | - Robert R J M Vermeiren
- d Department of Child and Adolescent Psychiatry, Leiden University Medical Centre, Curium-LUMC , Oegstgeest , The Netherlands.,e Department of Child and Adolescent Psychiatry Amsterdam, UMC location VU , Amsterdam , The Netherlands
| | - Mattijs E Numans
- a Department of Public Health and Primary Care, Leiden University Medical Centre , Leiden , The Netherlands
| | - Mathilde R Crone
- a Department of Public Health and Primary Care, Leiden University Medical Centre , Leiden , The Netherlands
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Mudd AE, Michael YL, Melly S, Moore K, Diez-Roux A, Forrest CB. Spatial accessibility to pediatric primary care in Philadelphia: an area-level cross sectional analysis. Int J Equity Health 2019; 18:76. [PMID: 31126295 PMCID: PMC6534862 DOI: 10.1186/s12939-019-0962-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Pediatric primary care visits are a foundational element in the health maintenance of children. Differential access may be a driver of racial inequities in health. We hypothesized that pediatric primary care accessibility would be lowest in neighborhoods with higher proportion of non-Hispanic Black residents. Methods Annual ratios (2008–2016) of providers to pediatric population were calculated by census tract in Philadelphia, Pennsylvania. Marginal logistic regression was used to estimate the independent association between neighborhood racial composition and access to pediatric primary care controlling for confounders. Results In general, low access to care was associated with greater neighborhood disadvantage (e.g., SES, % poverty, % public insurance). After controlling for neighborhood indicators of disadvantage, risk of being in the lowest quintile of access significantly increased as the percent of non-Hispanic Black residents increased. Conclusion A new measure of pediatric primary care accessibility demonstrates a persistent disparity in primary care access for predominantly non-Hispanic Black neighborhoods.
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Affiliation(s)
- Abigail E Mudd
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA.
| | - Yvonne L Michael
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Steven Melly
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Kari Moore
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Ana Diez-Roux
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Zuckerbrot RA, Cheung A, Jensen PS, Stein RE, Laraque D, Levitt A, Birmaher B, Campo J, Clarke G, Emslie G, Kaufman M, Kelleher KJ, Kutcher S, Malus M, Sacks D, Waslick B, Sarvet B. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics 2018; 141:peds.2017-4081. [PMID: 29483200 DOI: 10.1542/peds.2017-4081] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To update clinical practice guidelines to assist primary care (PC) clinicians in the management of adolescent depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of adolescent depression in PC settings. METHODS By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience. RESULTS Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of adolescent depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of adolescents with depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of depression in youth who are at high risk; (4) systematic assessment procedures by using reliable depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan. CONCLUSIONS This part of the guidelines is intended to assist PC clinicians in the identification and initial management of adolescents with depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for depression management in adolescents. Additional research that addresses the identification and initial management of youth with depression in PC is needed, including empirical testing of these guidelines.
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Affiliation(s)
- Rachel A. Zuckerbrot
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical Center, and New York State Psychiatric Institute, New York, New York
| | | | - Peter S. Jensen
- University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Ruth E.K. Stein
- Albert Einstein College of Medicine, Bronx, New York, New York; and
| | - Danielle Laraque
- State University of New York Upstate Medical University, Syracuse, New York
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Biel MG, Beers LS, Godoy L, Mlynarski L, Anthony BJ. Authors' Response to Comment on "Collaborative Training Efforts with Pediatric Providers in Addressing Mental Health Problems in Primary Care". ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:855-856. [PMID: 29039123 DOI: 10.1007/s40596-017-0839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Matthew G Biel
- Georgetown University School of Medicine, Washington DC, USA.
| | - Lee S Beers
- Children's National Health System, Washington DC, USA
| | - Leandra Godoy
- Children's National Health System, Washington DC, USA
| | - Laura Mlynarski
- Georgetown University School of Medicine, Washington DC, USA
| | - Bruno J Anthony
- Georgetown University School of Medicine, Washington DC, USA
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13
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Brown JD, King MA, Wissow LS. The Central Role of Relationships With Trauma-Informed Integrated Care for Children and Youth. Acad Pediatr 2017; 17:S94-S101. [PMID: 28185977 DOI: 10.1016/j.acap.2017.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/30/2016] [Accepted: 01/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Primary care plays an essential role in the primary and secondary prevention of children's mental health problems. A growing series of trials have shown the capacity of primary care providers to deliver care that specifically addresses risks to healthy social and emotional development by incorporating mental health services into their routines and integrating their work with the mental health care system. In this article elements common to various integration schemes that seem essential to their success are described. METHODS Narrative review, combining conclusions from 3 previous systematic reviews. RESULTS Trusting, personal relationships between patients and providers, and among collaborating providers, are a critical element of successful trauma-informed integrated care. Patient-provider relationships are essential to disclosure of sensitive concerns, to engaging patients in care, and to designing care that is responsive to individual patient needs. Studies of patient-centered care and psychotherapy suggest ways that these relationships can be built and maintained. Provider-provider relationships are, in turn, essential to coordinating the work of the range of providers and services needed to address trauma prevention and treatment. These relationships can form within a variety of organizational structures but building them might require staff training, redesign of work flows, and support from organizational structures and goals. CONCLUSIONS A variety of interventions at the patient-provider, clinical site, system, and policy levels can foster relationships and provide the foundation for care capable of addressing promotion of social and emotional well-being in general and trauma prevention and treatment in particular.
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Affiliation(s)
| | - Melissa A King
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Lawrence S Wissow
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Md.
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14
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Carpenter AL, Pincus DB, Perrin EC, Bair-Merritt MH, Mian ND. Early identification of anxiety disorders: The role of the pediatrician in primary care. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1275642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Donna B. Pincus
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Ellen C. Perrin
- Floating Hospital, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | | | - Nicholas D. Mian
- Department of Psychology, University of New Hampshire at Manchester, Manchester, NH
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15
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Racial/Ethnic Differences in the Prevalence of Anxiety Using the Vanderbilt ADHD Scale in a Diverse Community Outpatient Setting. J Dev Behav Pediatr 2016; 37:610-8. [PMID: 27541582 PMCID: PMC5039053 DOI: 10.1097/dbp.0000000000000330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pediatric anxiety is prevalent but frequently underdiagnosed compared with other behavioral conditions in primary care practice. Pediatricians routinely screen for attention-deficit hyperactivity disorder using the Vanderbilt Rating Scale, which includes a short screen for anxiety. We sought to examine the prevalence of potential anxiety among patients whose parents originally had concerns of disruptive behavior in a diverse setting and examine differences in anxiety across ethnic groups using the Vanderbilt ADHD Diagnostic Rating Scale (VADRS). METHOD This was a cross-sectional analysis of medical records data of children between the ages of 5 to 12 years whose parents had concerns of disruptive behavior and received primary care from May 25, 2010, to January 31, 2014 at 2 pediatric community health clinics in Indianapolis. RESULTS Sixteen percent of children whose parents had concerns for disruptive behavior screened positive for anxiety based on the VADRS screen. Hispanic parents were less likely to report symptoms of anxiety (Spanish speaking: adjusted odds ratio (AOR) 0.4, 95% confidence interval (CI), 0.2-0.8; English speaking: AOR 0.3, 95% CI, 0.1-0.9) compared with white and black families. CONCLUSION Anxiety is detected at a lower rate among Hispanic pediatric patients using the VADRS. This may suggest differences in the performance of the VADRS among Spanish-speaking families.
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16
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Radovic A, Reynolds K, McCauley HL, Sucato GS, Stein BD, Miller E. Parents' Role in Adolescent Depression Care: Primary Care Provider Perspectives. J Pediatr 2015; 167:911-8. [PMID: 26143382 PMCID: PMC4586359 DOI: 10.1016/j.jpeds.2015.05.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/09/2015] [Accepted: 05/26/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To understand how primary care providers (PCPs) perceive barriers to adolescent depression care to inform strategies to increase treatment engagement. STUDY DESIGN 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Ana Radovic
- Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine,Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Kerry Reynolds
- RAND Corporation, University of Pittsburgh School of Medicine
| | - Heather L. McCauley
- Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine,Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Gina S. Sucato
- Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine,Department of Pediatrics, University of Pittsburgh School of Medicine,Group Health, University of Pittsburgh School of Medicine
| | - Bradley D. Stein
- RAND Corporation, University of Pittsburgh School of Medicine,Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Elizabeth Miller
- Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine,Department of Pediatrics, University of Pittsburgh School of Medicine
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17
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Hourigan SE, Southam-Gerow MA, Quinoy AM. Emotional and behavior problems in an urban pediatric primary care setting. Child Psychiatry Hum Dev 2015; 46:289-99. [PMID: 24828702 DOI: 10.1007/s10578-014-0469-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We sought to identify needs for behavioral health care in a large, urban pediatric primary care (PPC) clinic serving a population covered by Medicaid. Specifically, children (N = 197; 120 girls; 91 % African American) ages 8-17 years and their caregivers completed measures of internalizing and externalizing symptoms (RCADS, RCADS-P, MASC, and SDQ). Clinical elevations on all but one domain of the SDQ were significantly higher than expected. However, self-reported anxiety and depression symptoms were consistent with expectations. These findings suggest urban, low-income, primarily African American youth presenting at a PPC clinic demonstrate significant levels of behavioral and emotional symptoms. Implications of the findings include the need to ask both parents and children about child behavioral health problems and the possible influence of screening tool selection on detection.
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18
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Biel MG, Kahn NF, Srivastava A, Mete M, Banh MK, Wissow LS, Anthony BJ. Parent Reports of Mental Health Concerns and Functional Impairment on Routine Screening With the Strengths and Difficulties Questionnaire. Acad Pediatr 2015; 15:412-20. [PMID: 25922333 PMCID: PMC4492834 DOI: 10.1016/j.acap.2015.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study used the Strengths and Difficulties Questionnaire (SDQ) to describe the prevalence of parent-reported mental health (MH) concerns in youth presenting for primary care appointments and to examine relationships between children's MH issues and functional impairment. We hypothesized that increased MH symptomology would be associated with increased impairment and family burden. METHODS Parents of 4- to 17-year-old children were approached at routine visits in 13 primary care sites. Chi-square tests, independent sample t tests, and a 1-way analysis of variance (ANOVA) were used to make comparisons between demographic groups. Age-, sex-, and race-adjusted ordered logistic regression models and ANOVAs examined relationships between impact and SDQ scales. RESULTS Boys had higher total Hyperactivity and Peer Problems. Adolescents showed higher Emotional Symptoms, while younger children showed more Hyperactivity. Latinos reported more Conduct Problems, Hyperactivity, and Peer Problems. Latinos also indicated less distress on the child, impairment at home and school, and family burden. Regression analyses indicated increased odds of impairment with higher scale scores. MH symptoms identified with the SDQ in pediatric primary care settings were associated with parent-reported impairment affecting youth and their families. CONCLUSIONS The presence of significant impairment suggests that parents' concerns identified by screening are likely to be clinically important and worthy of practice strategies designed to promote assessment, treatment, and referral for these common problems. Identifying and exploring parents' concerns with strategic use of screening tools may allow primary care providers to directly engage families around the MH issues that affect them most.
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Affiliation(s)
- Matthew G. Biel
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC
| | - Nicole F. Kahn
- Georgetown University Center for Child and Human Development, Washington, DC
| | - Anjuli Srivastava
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD
| | - My K. Banh
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC,Georgetown University Center for Child and Human Development, Washington, DC
| | | | - Bruno J. Anthony
- Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC,Georgetown University Center for Child and Human Development, Washington, DC
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19
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Lê Cook B, Brown JD, Loder S, Wissow L. Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. J Immigr Minor Health 2014; 16:1093-102. [PMID: 24705736 PMCID: PMC4185306 DOI: 10.1007/s10903-014-0010-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Significant Latino-white disparities in youth mental health care access and quality exist yet little is known about Latino parents' communication with providers about youth mental health and the role of acculturation in influencing this communication. We estimated regression models to assess the association between time in the US and the number of psychosocial issues discussed with the medical assistant (MA) and doctor, adjusting for child and parent mental health and sociodemographics. Other proxies of acculturation were also investigated including measures of Spanish and English language proficiency and nativity. Parent's length of time in the US was positively associated with their communication of: their child's psychosocial problems with their child's MA, stress in their own life with their child's MA, and their child's school problems with their child's doctor. These differences were especially apparent for parents living in the US for >10 years. Parent-child language discordance, parent and child nativity were also significantly associated with communication of psychosocial problems. Greater provider and MA awareness of variation in resistance to communicating psychosocial issues could improve communication, and improve the prevention, diagnosis and treatment of youth mental illness.
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Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Assistant Professor, Department of Psychiatry, Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8449, 617-503-8430 (fax),
| | - Jonathan D. Brown
- Mathematica Policy Research, 1100 1st St NE #1200, Washington, DC 20002, (202) 484-9220,
| | - Stephen Loder
- Center for Multicultural Mental Health Research, Cambridge Health, Alliance, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8440, 617-503-8430 (fax),
| | - Larry Wissow
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, #703 Baltimore, MD 21287, 410-614-1243,
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20
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Kolko DJ, Perrin E. The integration of behavioral health interventions in children's health care: services, science, and suggestions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2014. [PMID: 24588366 DOI: 10.1080/15374416.2013.862804.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.
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Affiliation(s)
- David J Kolko
- a Department of Psychiatry , University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic
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21
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Kolko DJ, Perrin E. The integration of behavioral health interventions in children's health care: services, science, and suggestions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 43:216-28. [PMID: 24588366 DOI: 10.1080/15374416.2013.862804] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.
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Affiliation(s)
- David J Kolko
- a Department of Psychiatry , University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic
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22
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Stephan SH, Connors EH. School nurses' perceived prevalence and competence to address student mental health problems. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/1754730x.2013.808889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Brown JD, Wissow LS, Cook BL, Longway S, Caffery E, Pefaure C. Mental health communications skills training for medical assistants in pediatric primary care. J Behav Health Serv Res 2013; 40:20-35. [PMID: 23070564 DOI: 10.1007/s11414-012-9292-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Paraprofessional medical assistants (MAs) could help to promote pediatric primary care as a source of mental health services, particularly among patient populations who receive disparate mental health care. This project piloted a brief training to enhance the ability of MAs to have therapeutic encounters with Latino families who have mental health concerns in pediatric primary care. The evaluation of the pilot found that MAs were able to master most of the skills taught during the training, which improved their ability to have patient-centered encounters with families during standardized patient visits coded with the Roter Interaction Analysis System. Parents interviewed 1 and 6 months following the training were more than twice as willing as parents interviewed 1 month before the training to discuss mental health concerns with MAs, and they had better perceptions of their interactions with MAs (all p < 0.01) even after controlling for a range of patient and visit characteristics. Before training, 10.2% of parents discussed a mental health concern with the MA but not the physician; this never happened 6 months after training. This pilot provides preliminary evidence that training MAs holds potential to supplement other educational and organizational interventions aimed at improving mental health services in pediatric primary care, but further research is necessary to test this type of training in other settings and among different patient populations.
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Rethinking the mental health treatment skills of primary care staff: a framework for training and research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 39:489-502. [PMID: 21915748 DOI: 10.1007/s10488-011-0373-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Health care reforms may offer several opportunities to build the mental health treatment capacity of primary care. Capitalizing on these opportunities requires identifying the types of clinical skills that the primary care team requires to deliver mental health care. This paper proposes a framework that describes mental health skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians. These skills are organized on three levels: cross-cutting skills to build therapeutic alliance; broad-based, brief interventions for major clusters of mental health symptoms; and evidence-based interventions for diagnosis specific disorders. This framework is intended to help inform future mental health training in primary care and catalyze research that examines the impact of such training.
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25
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The Social Dynamics of Responding to Mental Health Problems. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/978-94-007-4276-5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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26
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Dempster RM, Wildman BG, Langkamp D, Duby JC. Pediatrician Identification of Child Behavior Problems: The Roles of Parenting Factors and Cross-Practice Differences. J Clin Psychol Med Settings 2011; 19:177-87. [DOI: 10.1007/s10880-011-9268-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jee SH, Szilagyi M, Conn AM, Nilsen W, Toth S, Baldwin CD, Szilagyi PG. Validating office-based screening for psychosocial strengths and difficulties among youths in foster care. Pediatrics 2011; 127:904-10. [PMID: 21502256 DOI: 10.1542/peds.2010-1350] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of social-emotional screening in the primary care setting for youths in foster care. METHODS The setting was a primary care practice for all youth in home-based foster care in 1 county. Subjects were youths, aged 11 to 17 years, and their foster parents; both completed a Strengths and Difficulties Questionnaire at well-child visits. The Strengths and Difficulties Questionnaire is a previously validated 25-item tool that has 5 domains: emotional symptoms; conduct problems; hyperactivity/inattention; peer problems; and prosocial behaviors and an overall total difficulties score. We first compared youth versus parent Strengths and Difficulties Questionnaire scores and then assessed the accuracy of these Strengths and Difficulties Questionnaire scores by comparing them in a subsample of youths (n = 50) with results of home-based structured clinical interviews using the Children's Interview for Psychiatric Syndromes. RESULTS Of 138 subjects with both youth and parent reports, 78% had prosocial behaviors (strengths), and 70% had 1 or more social-emotional problems. Parents reported significantly more conduct problems (38% vs 16%; P < .0001) and total difficulties (30% vs 16%; P = .002) than did youth. The Strengths and Difficulties Questionnaire had better agreement with the Children's Interview for Psychiatric Syndromes (n = 50) for any Strengths and Difficulties Questionnaire-identified problem for combined youth and foster-parent reports (93%), compared with youth report alone (54%) or parent report alone (71%). CONCLUSIONS Although most youths in foster care have social-emotional problems, most have strengths as well. Youth and foster-parent perspectives on these problems differ. Systematic social-emotional screening in primary care that includes both youth and parent reports can identify youths who may benefit from services.
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Meadows T, Valleley R, Haack MK, Thorson R, Evans J. Physician "costs" in providing behavioral health in primary care. Clin Pediatr (Phila) 2011; 50:447-55. [PMID: 21196418 DOI: 10.1177/0009922810390676] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. METHODS Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22% of patient visits, was ≥90%. RESULTS Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. CONCLUSION Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement.
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Affiliation(s)
- Tawnya Meadows
- University of Nebraska Medical Center, Omaha, NE 69198, USA.
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Wissow L, Gadomski A, Roter D, Larson S, Lewis B, Brown J. Aspects of mental health communication skills training that predict parent and child outcomes in pediatric primary care. PATIENT EDUCATION AND COUNSELING 2011; 82:226-32. [PMID: 20444568 PMCID: PMC2947561 DOI: 10.1016/j.pec.2010.03.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 03/09/2010] [Accepted: 03/31/2010] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Training in communication can change clinician behaviors, but brief training may function by altering attitudes rather than teaching new skills. We used data from a trial of mental health training for office-based primary care to determine indicators of uptake that predicted parent and child outcomes. METHODS Clinicians (n=50) were randomized to be controls or receive training. Uptake was determined comparing pre- and post-training visits with standardized patients (SPs) coded for skills and patient centeredness. Clinical outcomes were assessed by recruiting and following 403 children/youth ages 5-16 making visits to participants. At 6 months, change in mental health was assessed by parent and youth reports using the Strengths and Difficulties Questionnaire. RESULTS Trained clinicians used more agenda setting, time, and anger management skills than controls and showed increased patient centeredness toward SP parents, but not adolescents. Increased patient-centeredness toward parents predicted improvement in child/youth symptoms and functioning (rated by parents), and improvement in youth-rated symptoms. Increased skills alone were not associated with improvement, but patients of clinicians above the mean for both skill and patient-centeredness change improved most.
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Affiliation(s)
- Lawrence Wissow
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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30
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Garfunkel LC, Pisani AR, leRoux P, Siegel DM. Educating residents in behavioral health care and collaboration: comparison of conventional and integrated training models. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:174-9. [PMID: 21169773 PMCID: PMC4176864 DOI: 10.1097/acm.0b013e318204ff1d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To determine whether former pediatric residents trained using a model of integrated behavioral health (BH) care in their primary care continuity clinics felt more comfortable managing BH care and better prepared to collaborate with BH professionals than did peers from the same residency who trained in clinics with a conventional model of BH care. METHOD University of Rochester School of Medicine and Dentistry pediatric residents were assigned to one of two continuity clinic sites. At one site, psychology fellows and faculty were integrated into the clinic teams in the mid-1990s. At the other, conventional patterns of consultation and referral continued. In 2004, the authors surveyed 245 alumni (graduated 1989-2003) about their experiences and their comfort with providing BH care and collaborating with BH providers in their current practice. RESULTS A total of 174 alumni (71%) responded. There were significant differences between graduates who trained in the two models. Those who trained in the integrated model were significantly more likely than others to report that they had consulted or planned treatment with a BH provider during residency and to report that their continuity clinic helped prepare them to collaborate with BH providers. They were somewhat more likely to believe that their overall residency training prepared them to manage BH issues in their current practice. CONCLUSIONS These findings suggest that an integrated training environment, described in detail in the companion article in this issue, can enhance pediatric resident education in the management of BH problems and collaboration with BH specialists.
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Affiliation(s)
- Lynn C. Garfunkel
- Department of Pediatrics University of Rochester/Rochester General Hospital
| | - Anthony R. Pisani
- Departments of Psychiatry and Pediatrics University of Rochester/Rochester General Hospital
| | - Pieter leRoux
- Departments of Psychiatry and Pediatrics University of Rochester/Rochester General Hospital
| | - David M. Siegel
- Departments of Pediatrics and Medicine University of Rochester/Rochester General Hospital
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Quality of care for childhood attention-deficit/hyperactivity disorder in a managed care medicaid program. J Am Acad Child Adolesc Psychiatry 2010; 49:1225-37, 1237.e1-11. [PMID: 21093772 PMCID: PMC3018146 DOI: 10.1016/j.jaac.2010.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 08/13/2010] [Accepted: 08/23/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether clinical severity is greater among children receiving attention-deficit/hyperactivity disorder (ADHD) care in primary care compared with those in specialty mental health clinics, and to examine how care processes and clinical outcomes vary by sector across three 6-month time intervals. METHOD This was a longitudinal cohort study of 530 children aged 5 to 11 years receiving ADHD care in primary care or specialty mental health clinics from November 2004 through September 2006 in a large, countywide managed care Medicaid program. RESULTS Clinical severity at study entry did not differ between children who received ADHD care in solely primary or specialty mental health care clinics. At three 6-month intervals, receipt of no care ranged from 34% to 44%, and unmet need for mental health services ranged from 13% to 20%. In primary care, 80% to 85% of children had at least one stimulant prescription filled and averaged one to two follow-up visits per year. Less than one-third of children in specialty mental health clinics received any stimulant medication, but all received psychosocial interventions averaging more than five visits per month. In both sectors, stimulant medication refill prescription persistence was poor (31%-49%). With few exceptions, ADHD diagnosis, impairment, academic achievement, parent distress, and parent-reported treatment satisfaction, perceived benefit, and improved family functioning did not differ between children who remained in care and those who received no care. CONCLUSION Areas for quality improvement are alignment of clinical severity with provider type, follow-up visits, stimulant use in specialty mental health, agency data infrastructure to document delivery of evidence-based psychosocial treatment, and stimulant medication refill prescription persistence.
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Suldo SM, Friedrich A, Michalowski J. Personal and systems-level factors that limit and facilitate school psychologists' involvement in school-based mental health services. PSYCHOLOGY IN THE SCHOOLS 2010. [DOI: 10.1002/pits.20475] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brown JD. Pediatric primary care as a component of systems of care. EVALUATION AND PROGRAM PLANNING 2010; 33:36-38. [PMID: 19552954 DOI: 10.1016/j.evalprogplan.2009.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 04/10/2009] [Accepted: 04/10/2009] [Indexed: 05/28/2023]
Abstract
Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of care is defined as serving only children and youth with serious emotional disturbance and their families and does not fully embrace the concept of primary prevention. Although similarities in the definitions of primary care and systems of care may provide a theoretical foundation for including primary care within the systems of care framework, a definition of systems of care that incorporates the idea of prevention and takes into account the broad population served in primary care would provide communities with a definition that can be used to further the work of integrating primary care into systems of care.
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Affiliation(s)
- Jonathan D Brown
- Mathematica Policy Research, 600 Maryland Ave SW Suite 500, Washington, DC 20024, USA.
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Kelleher KJ, Gardner WP. Thinking systematically about early identification. J Adolesc Health 2009; 44:516-7. [PMID: 19465313 PMCID: PMC2689926 DOI: 10.1016/j.jadohealth.2009.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
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Kelleher KJ, Stevens J. Evolution of child mental health services in primary care. Acad Pediatr 2009; 9:7-14. [PMID: 19329085 PMCID: PMC2699251 DOI: 10.1016/j.acap.2008.11.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 11/20/2008] [Accepted: 11/24/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Although the importance of mental health assessment and treatment in primary care is increasingly recognized, the research that underlies current practices largely stems from a considerable body of non-mental health primary care studies. Our purpose was to describe trends in research over the past 2 decades and to suggest further key items for the research agenda. METHODS We reviewed the literature broadly on health services research in pediatrics, especially studies of changes in primary care practice, and examined recent articles in primary care mental health services. RESULTS The evolution of primary care mental health services for children has been slow, but the focus of research has changed with the development of clinical improvements. Proposals to deliver more effective services have evolved over the past 40 years in a series of approaches that paralleled initiatives in the broader fields of medicine and pediatrics. Current trends in electronic technology, practice consolidation and coordination, and personalized medicine are likely to increase the pace of change in mental health services for primary care. CONCLUSIONS The evolution of pediatric mental health services in primary care suggests a continuing expansion from a focus initially on provider behavior and quality to a growing attention to patient and systems' behavior over time and within communities.
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Affiliation(s)
- Kelly J Kelleher
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Brown JD, Wissow LS. Discussion of sensitive health topics with youth during primary care visits: relationship to youth perceptions of care. J Adolesc Health 2009; 44:48-54. [PMID: 19101458 PMCID: PMC2630026 DOI: 10.1016/j.jadohealth.2008.06.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 06/23/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Youth have concerns about sensitive health topics, such as drugs, sex, and mental health, and many wish to discuss those concerns with a primary care provider. Research has not determined whether the discussion of sensitive health topics during primary care visits is independently associated with youth perceptions of care. This study examined whether the discussion of sensitive health topics during primary care visits was associated with youth's perceptions of the provider and of participation in treatment. METHODS Directly after visits to 54 primary care providers in 13 geographically diverse offices and clinics, youth age 11-16 years old (N = 358) reported whether the visit included the discussion of mood, behavior, getting along with others, drugs, tobacco, alcohol, sexuality, birth control, parent mood, or family problems. Youth also reported whether the provider understood their problems, eased their worries, allowed them to make decisions about treatment, gave them some control over treatment, and asked them to take some responsibility for treatment. Providers reported confidence in their ability to offer counseling for nonmedical concerns and their beliefs and attitudes toward treating nonmedical concerns. RESULTS Youth had more positive perceptions of the provider and were more likely to report taking an active role in treatment when the visit included the discussion of a sensitive health topic. Results from multivariate random effects logistic regression suggested that youth were more likely to report that the provider understood their problems (OR = 3.62, CI = 1.57-8.31), eased their worries (OR = 2.13, CI = 1.06-3.92), allowed them to make decisions about treatment (OR = 2.71, CI = 1.44-5.10), gave them some control over treatment (OR = 2.51, CI = 1.32-4.71), and asked them to take some responsibility for treatment (OR = 2.00, CI = 1.04-3.86) when the visit included the discussion of one or more sensitive health topics. The odds of each of these outcomes were also higher when the visit included the discussion of a greater number of sensitive topics. Youth also had more positive perceptions of female providers. Youth demographics, mental health status, and other provider characteristics were unrelated to youth perceptions of care. CONCLUSIONS The discussion of sensitive health topics during primary care visits may have a positive impact on youth perceptions of care. Future research is needed to understand the relationship between the discussion of sensitive health topics and health outcomes among youth.
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Brown JD, Wissow LS. Disagreement in parent and primary care provider reports of mental health counseling. Pediatrics 2008; 122:1204-11. [PMID: 19047235 DOI: 10.1542/peds.2007-3495] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to examine disagreement in primary care provider and parent reports of mental health counseling and to determine whether disagreement was associated with provider, parent, youth, and visit characteristics. METHODS Directly after 749 visits to 54 pediatric primary care providers in 16 practices, the parents of youths 5 to 16 years of age and the providers independently reported whether mental health counseling was provided. The parent also reported child mental health symptoms, the reason for the visit, and his or her attitudes about receiving treatment for child mental health problems in primary care. The provider reported confidence in his or her mental health treatment skills, burden and beliefs associated with treating mental health problems, and the accessibility of mental health specialists. RESULTS Providers reported delivering counseling during 31.9% of visits (n=239), whereas parents reported receiving counseling during only 11.4% of visits (n=86). Parents did not report receiving counseling during 74.8% of the visits in which the provider reported delivering counseling; this was more common when the parent was seeking help for a mental health problem, when the provider reported greater burden associated with treating mental health problems, and when the youth had more mental health symptoms or was of other race/Hispanic. Provider report of counseling in the absence of parent report of counseling was less common when the provider had greater access to mental health specialists. CONCLUSIONS Parents often did not report that the counseling delivered in primary care was mental health treatment. Counseling that is not perceived as mental health treatment may fail to meet parent expectations for care or fail to help parents identify mental health problems.
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Affiliation(s)
- Jonathan D Brown
- Mathematica Policy Research, 600 Maryland Ave SW, Suite 550, Washington, DC 20024-2512, USA.
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Wissow L, Anthony B, Brown J, DosReis S, Gadomski A, Ginsburg G, Riddle M. A common factors approach to improving the mental health capacity of pediatric primary care. ADMINISTRATION AND POLICY IN MENTAL HEALTH 2008. [PMID: 18543097 DOI: 10.1007/s10488-008-0178-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To expand the mental health service capacity of pediatric primary care, we ask whether there are evidence-based skills to allow providers to 1) immediately begin treatment for children with emotional and behavioral problems while diagnostic procedures are being pursued, and 2) offer evidence-based care to children who do not meet criteria for a specific diagnosis. We discuss why the epidemiology of child mental health problems poses difficulties for disorder-specific mental health interventions, and review evidence that "common factors" contributing to the outcome of mental health treatments define a core set of skills that primary care providers might use to complement disorder-specific interventions.
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Affiliation(s)
- Larry Wissow
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Wissow L, Anthony B, Brown J, DosReis S, Gadomski A, Ginsburg G, Riddle M. A common factors approach to improving the mental health capacity of pediatric primary care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2008; 35:305-18. [PMID: 18543097 DOI: 10.1007/s10488-008-0178-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 05/13/2008] [Indexed: 11/29/2022]
Abstract
To expand the mental health service capacity of pediatric primary care, we ask whether there are evidence-based skills to allow providers to 1) immediately begin treatment for children with emotional and behavioral problems while diagnostic procedures are being pursued, and 2) offer evidence-based care to children who do not meet criteria for a specific diagnosis. We discuss why the epidemiology of child mental health problems poses difficulties for disorder-specific mental health interventions, and review evidence that "common factors" contributing to the outcome of mental health treatments define a core set of skills that primary care providers might use to complement disorder-specific interventions.
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Affiliation(s)
- Larry Wissow
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Kemper KJ, Foy JM, Wissow L, Shore S. Enhancing communication skills for pediatric visits through on-line training using video demonstrations. BMC MEDICAL EDUCATION 2008; 8:8. [PMID: 18267028 PMCID: PMC2262077 DOI: 10.1186/1472-6920-8-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 02/11/2008] [Indexed: 05/10/2023]
Abstract
BACKGROUND Training in communication skills for health professionals is important, but there are substantial barriers to individual in-person training for practicing clinicians. We evaluated the feasibility and desirability of on-line training and sought suggestions for future courses. METHODS Based on successful in-person curricula for communication skills and our previous on-line curricula, we created an on-line course consisting of 28 modules (4.75 hours CME credit) about communication skills during pediatric visits that included a mental health concern; each module included a brief case, a multiple choice question, an explanation, and a 1-2 minute video demonstrating key skills. Specific communication skills included: greeting, setting an agenda, discussing diagnosis and treatment, and managing negative interactions. The course was announced by emails in spring, 2007; the course was available on-line for 60 days; we aimed to enroll 50 clinicians. Outcomes were analyzed for those who evaluated the course within 75 days of its initial availability. RESULTS Overall, 61 clinicians registered, of whom most were nurses (N = 24), physicians (N = 22), or psychologists or social workers (N = 12). Of the 36 (59%) clinicians who evaluated the course, over 85% agreed that all course objectives had been met; over 90% reported greater confidence in greetings and agenda-setting; and over 80% reported greater confidence in discussing diagnosis and treatment and managing negative interactions. Nearly all, 97% would recommend the course to other clinicians and trainees. Suggestions for improvement included a library of additional video vignettes and written materials to accompany the on-line training. CONCLUSION On-line training in communication skills for pediatric mental health visits is feasible, desirable and associated with increased confidence in key skills. Positive feedback from clinicians suggests that a comparison of on-line versus in-person training is warranted.
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Affiliation(s)
- Kathi J Kemper
- Departments of Pediatrics and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jane M Foy
- Departments of Pediatrics and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Larry Wissow
- Departments of Psychiatry and Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Steve Shore
- Executive Director, NC Pediatric Society, Raleigh, NC, USA
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Receiving advice about child mental health from a primary care provider: African American and Hispanic parent attitudes. Med Care 2007; 45:1076-82. [PMID: 18049348 DOI: 10.1097/mlr.0b013e31812da7fd] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary care providers (PCPs) play a critical role in the identification and treatment of child and adolescent mental health problems but few studies have examined parents' attitudes on receiving advice about child mental health from a PCP and whether attitudes are associated with race or ethnicity. OBJECTIVE To determine if race and ethnicity were associated with parents' attitudes on receiving advice about child mental health from a PCP. SUBJECTS Data were collected during 773 visits to 54 PCPs in 13 diverse clinics. Families were 56.5% white, 33.3% African American, and 10.1% Hispanic. MEASURES The parent reported attitudes associated with receiving advice about child mental health from the PCP. The parent completed the Strengths and Difficulties Questionnaire to report youth mental health. PCPs completed measures of psychosocial orientation, confidence in mental health treatment skills, and the accessibility of mental health specialists. RESULTS Hispanics were more likely than Non-Hispanics to agree that PCPs should treat child mental health and were more willing to allow their child to receive medications or visit a therapist for a mental health problem if recommended by the PCP. African Americans were significantly less willing than whites and Hispanics to allow their child to receive medication for mental health but did not differ in their willingness to visit a therapist. CONCLUSIONS Race and ethnicity were associated with parents' attitudes on receiving advice about child mental health from a PCP. Primary care may be a good point of intervention for Hispanic youth with mental health needs.
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