Skip to main content
Top
Gepubliceerd in: Journal of Child and Family Studies 12/2017

08-09-2017 | Original Paper

Different Mental Health-Related Symptoms, Different Decisions: A Survey of Pediatric Primary Care Providers

Auteurs: Anne E. Pidano, Lourdes P. Dale, Chelsea Dru Morgan, Kaitlyn L. Wilbur, Preeti Sandhu, Lisa Honigfeld

Gepubliceerd in: Journal of Child and Family Studies | Uitgave 12/2017

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

As many as 20% of children are need in of mental health services but only a small percentage receive them. Primary care pediatricians are often the first providers to see these children so it is critical to understand how they manage their care. Therefore, we developed a vignette-based survey to obtain data about pediatricians’ mental health-related diagnostic accuracy, confidence and comfort level in diagnosis and management, and decisions related to care. Pediatricians (N = 106) responded to one of two vignettes, one describing a child with symptoms consistent with ADHD, inattentive type, and the other with symptoms of a depressive disorder. Overall diagnostic accuracy was ~60%, although pediatricians who received the ADHD vignette indicated greater confidence in their diagnosis and greater likelihood of providing treatment themselves. Those who received the ADHD vignette were also more likely to conduct a next level assessment and not to refer to a specialist. Participant characteristics, other than level of interest in mental health, were generally not associated with accuracy, confidence, comfort level, and decisions. Neither years in practice nor completion of a residency rotation in developmental and behavioral pediatrics yielded significant differences in or correlations with diagnosis and management. Consistent with previous reports, pediatric primary care providers vary in their responses to mental health concerns, depending upon the symptom presentation. Primary care providers in our study also appear to value consultation with mental health specialists, supporting the importance of interprofessional collaboration in caring for children with mental health related concerns.
Literatuur
go back to reference American Academy of Pediatrics. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022. doi:10.1542/peds.2011-2654.CrossRef American Academy of Pediatrics. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022. doi:10.​1542/​peds.​2011-2654.CrossRef
go back to reference American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health. (1993). The pediatrician and the “new morbidity”. Pediatrics, 92(5), 731–733. American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health. (1993). The pediatrician and the “new morbidity”. Pediatrics, 92(5), 731–733.
go back to reference American Academy of Pediatrics (2010). AAP website. Addressing mental health concerns in primary care: A clinician’s toolkit. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Pages/Addressing-Mental-Health-Concerns-in-Primary-Care-A-Clinicians-Toolkit.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token. American Academy of Pediatrics (2010). AAP website. Addressing mental health concerns in primary care: A clinician’s toolkit. Retrieved from https://​www.​aap.​org/​en-us/​advocacy-and-policy/​aap-health-initiatives/​Mental-Health/​Pages/​Addressing-Mental-Health-Concerns-in-Primary-Care-A-Clinicians-Toolkit.​aspx?​nfstatus=​401&​nftoken=​00000000-0000-0000-0000-000000000000&​nfstatusdescript​ion=​ERROR%3a+No+local+token.
go back to reference American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
go back to reference Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., & Stein, R. E. (2007). Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics, 120(5), e1313–e1326.CrossRefPubMed Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., & Stein, R. E. (2007). Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics, 120(5), e1313–e1326.CrossRefPubMed
go back to reference Davis, D. W., Honaker, S. M., Jones, V. F., Williams, P. G., Stocker, F., & Martin, E. (2012). Identification and management of behavioral/mental health problems in primary care pediatrics perceived strengths, challenges, and new delivery models. Clinical Pediatrics, 51(10), 978–982.CrossRefPubMed Davis, D. W., Honaker, S. M., Jones, V. F., Williams, P. G., Stocker, F., & Martin, E. (2012). Identification and management of behavioral/mental health problems in primary care pediatrics perceived strengths, challenges, and new delivery models. Clinical Pediatrics, 51(10), 978–982.CrossRefPubMed
go back to reference Fremont, W. P., Nastasi, R., Newman, N., & Roizen, N. J. (2008). Comfort level of pediatricians and family medicine physicians diagnosing and treating child and adolescent psychiatric disorders. The International Journal of Psychiatry in Medicine, 38(2), 153–168.CrossRefPubMed Fremont, W. P., Nastasi, R., Newman, N., & Roizen, N. J. (2008). Comfort level of pediatricians and family medicine physicians diagnosing and treating child and adolescent psychiatric disorders. The International Journal of Psychiatry in Medicine, 38(2), 153–168.CrossRefPubMed
go back to reference Holt, W. (2010). The Massachusetts Child Psychiatry Access Project: Supporting Mental Health Treatment in Primary Care. New York, NY: Commonwealth Fund. http://www.commonwealthfund.org/publications/case-studies/2010/mar/the-massachusetts-child-psychiatry-access-project Retrieved from. Holt, W. (2010). The Massachusetts Child Psychiatry Access Project: Supporting Mental Health Treatment in Primary Care. New York, NY: Commonwealth Fund. http://​www.​commonwealthfund​.​org/​publications/​case-studies/​2010/​mar/​the-massachusetts-child-psychiatry-access-project Retrieved from.
go back to reference Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74(3), 401.CrossRefPubMed Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74(3), 401.CrossRefPubMed
go back to reference Horwitz, S. M., Kelleher, K. J., Stein, R. E., Storfer-Isser, A., Youngstrom, E. A., Park, E. R., & Hoagwood, K. E. (2007). Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics, 119(1), e208–e218.CrossRefPubMed Horwitz, S. M., Kelleher, K. J., Stein, R. E., Storfer-Isser, A., Youngstrom, E. A., Park, E. R., & Hoagwood, K. E. (2007). Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics, 119(1), e208–e218.CrossRefPubMed
go back to reference Kelleher, K. J., Campo, J. V., & Gardner, W. P. (2006). Management of pediatric mental disorders in primary care: Where are we now and where are we going? Current Opinion in Pediatrics, 18(6), 649–653.CrossRefPubMed Kelleher, K. J., Campo, J. V., & Gardner, W. P. (2006). Management of pediatric mental disorders in primary care: Where are we now and where are we going? Current Opinion in Pediatrics, 18(6), 649–653.CrossRefPubMed
go back to reference Kim, W. J. (2003). Child and adolescent psychiatry workforce: A critical shortage and national challenge. Academic Psychiatry, 27(4), 277–282.CrossRefPubMed Kim, W. J. (2003). Child and adolescent psychiatry workforce: A critical shortage and national challenge. Academic Psychiatry, 27(4), 277–282.CrossRefPubMed
go back to reference Kolko, D. J., Campo, J. V., Kelleher, K., & Cheng, Y. (2010). Improving access to care and clinical outcome for pediatric behavioral problems: A randomized trial of a nurse-administered intervention in primary care. Journal of Developmental and Behavioral Pediatrics, 31(5), 393–404. Kolko, D. J., Campo, J. V., Kelleher, K., & Cheng, Y. (2010). Improving access to care and clinical outcome for pediatric behavioral problems: A randomized trial of a nurse-administered intervention in primary care. Journal of Developmental and Behavioral Pediatrics, 31(5), 393–404.
go back to reference Kolko, D. J., Campo, J. V., Kilbourne, A. M., & Kelleher, K. (2012). Doctor-office collaborative care for pediatric behavioral health problems: A preliminary clinical trial. Archives of Pediatric and Adolescent Medicine, 166(3), 224–231. Kolko, D. J., Campo, J. V., Kilbourne, A. M., & Kelleher, K. (2012). Doctor-office collaborative care for pediatric behavioral health problems: A preliminary clinical trial. Archives of Pediatric and Adolescent Medicine, 166(3), 224–231.
go back to reference Kolko, D. J., & Perrin, E. (2014). The integration of behavioral health interventions in children's health care: Services, science, and suggestions. Journal of Clinical Child & Adolescent Psychology, 43(2), 216–228 Kolko, D. J., & Perrin, E. (2014). The integration of behavioral health interventions in children's health care: Services, science, and suggestions. Journal of Clinical Child & Adolescent Psychology, 43(2), 216–228
go back to reference Olson, A. L., Kemper, K. J., Kelleher, K. J., Hammond, C. S., Zuckerman, B. S., & Dietrich, A. J. (2002). Primary care pediatricians’ roles and perceived responsibilities in the identification and management of maternal depression. Pediatrics, 110(6), 1169–1176.CrossRefPubMed Olson, A. L., Kemper, K. J., Kelleher, K. J., Hammond, C. S., Zuckerman, B. S., & Dietrich, A. J. (2002). Primary care pediatricians’ roles and perceived responsibilities in the identification and management of maternal depression. Pediatrics, 110(6), 1169–1176.CrossRefPubMed
go back to reference Pidano, A. E., Kimmelblatt, C. A., & Neace, W. P. (2011a). Behavioral health in the pediatric primary care setting: Needs, barriers, and implications for psychologists. Psychological Services, 8(3), 151.CrossRef Pidano, A. E., Kimmelblatt, C. A., & Neace, W. P. (2011a). Behavioral health in the pediatric primary care setting: Needs, barriers, and implications for psychologists. Psychological Services, 8(3), 151.CrossRef
go back to reference Pidano, A. E., Marcaly, K. H., Ihde, K. M., Kurowski, E. C., & Whitcomb, J. M. (2011b). Connecticut’s enhanced care clinic initiative: Early returns from pediatric–behavioral health partnerships. Families, Systems, & Health, 29(2), 138.CrossRef Pidano, A. E., Marcaly, K. H., Ihde, K. M., Kurowski, E. C., & Whitcomb, J. M. (2011b). Connecticut’s enhanced care clinic initiative: Early returns from pediatric–behavioral health partnerships. Families, Systems, & Health, 29(2), 138.CrossRef
go back to reference Pidano, A. E., Slater, C. M., Dale, L. P., Wilbur, K. L., Sandhu, P., & Honigfeld, L. (2016). Availability of telephone-based child psychiatry consultation: Implications from a survey of pediatric providers in two states. Journal of Child and Family Studies. Advance online publication. doi:10.1007/s10826-016-0423-8. Pidano, A. E., Slater, C. M., Dale, L. P., Wilbur, K. L., Sandhu, P., & Honigfeld, L. (2016). Availability of telephone-based child psychiatry consultation: Implications from a survey of pediatric providers in two states. Journal of Child and Family Studies. Advance online publication. doi:10.​1007/​s10826-016-0423-8.
go back to reference Sices, L., Feudtner, C., McLaughlin, J., Drotar, D., & Williams, M. (2004). How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design. Pediatrics, 113(2), 274–282. Retrieved from http://pediatrics.aappublications.org/content/113/2/274.CrossRefPubMed Sices, L., Feudtner, C., McLaughlin, J., Drotar, D., & Williams, M. (2004). How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design. Pediatrics, 113(2), 274–282. Retrieved from http://​pediatrics.​aappublications.​org/​content/​113/​2/​274.​CrossRefPubMed
go back to reference Stein, R. E., Horwitz, S. M., Storfer-Isser, A., Heneghan, A., Olson, L., & Hoagwood, K. E. (2008). Do pediatricians think they are responsible for identification and management of child mental health problems? Results of the AAP periodic survey. Ambulatory Pediatrics, 8(1), 11–17.CrossRefPubMed Stein, R. E., Horwitz, S. M., Storfer-Isser, A., Heneghan, A., Olson, L., & Hoagwood, K. E. (2008). Do pediatricians think they are responsible for identification and management of child mental health problems? Results of the AAP periodic survey. Ambulatory Pediatrics, 8(1), 11–17.CrossRefPubMed
go back to reference Stein, R. E., Storfer-Isser, A., Kerker, B. D., Garner, A., Szilagyi, M., Hoagwood, K. E., & Horwitz, S. M. (2016). Beyond ADHD: how well are we doing? Academic Pediatrics, 16(2), 115–121.CrossRefPubMed Stein, R. E., Storfer-Isser, A., Kerker, B. D., Garner, A., Szilagyi, M., Hoagwood, K. E., & Horwitz, S. M. (2016). Beyond ADHD: how well are we doing? Academic Pediatrics, 16(2), 115–121.CrossRefPubMed
go back to reference Stein, R. E., Storfer-Isser, A., Kerker, B. D., Garner, A., Szilagyi, M., Hoagwood, K. E., & Horwitz, S. M. (2017). Does length of developmental behavioral pediatrics training matter? Academic Pediatrics, 17(1), 61–67.CrossRefPubMed Stein, R. E., Storfer-Isser, A., Kerker, B. D., Garner, A., Szilagyi, M., Hoagwood, K. E., & Horwitz, S. M. (2017). Does length of developmental behavioral pediatrics training matter? Academic Pediatrics, 17(1), 61–67.CrossRefPubMed
go back to reference Sturm, R., Ringel, J. S., & Andreyeva, T. (2003). Geographic disparities in children’s mental health care. Pediatrics, 112(4), e308–e308.CrossRefPubMed Sturm, R., Ringel, J. S., & Andreyeva, T. (2003). Geographic disparities in children’s mental health care. Pediatrics, 112(4), e308–e308.CrossRefPubMed
go back to reference Wissow, L. S., van Ginneken, N., Chandna, J., & Rahman, A. (2016). Integrating children's mental health into primary care. Pediatric Clinics of North America, 63, 97–113. Wissow, L. S., van Ginneken, N., Chandna, J., & Rahman, A. (2016). Integrating children's mental health into primary care. Pediatric Clinics of North America, 63, 97–113.
go back to reference Wissow, L. S., Zafar, W., Fothergill, K., Ruble, A., & Slade, E. (2016b). Using vignettes to assess contributions to the work of addressing child mental health problems in primary care. BMC Health Services Research, 15(1), 1. Wissow, L. S., Zafar, W., Fothergill, K., Ruble, A., & Slade, E. (2016b). Using vignettes to assess contributions to the work of addressing child mental health problems in primary care. BMC Health Services Research, 15(1), 1.
Metagegevens
Titel
Different Mental Health-Related Symptoms, Different Decisions: A Survey of Pediatric Primary Care Providers
Auteurs
Anne E. Pidano
Lourdes P. Dale
Chelsea Dru Morgan
Kaitlyn L. Wilbur
Preeti Sandhu
Lisa Honigfeld
Publicatiedatum
08-09-2017
Uitgeverij
Springer US
Gepubliceerd in
Journal of Child and Family Studies / Uitgave 12/2017
Print ISSN: 1062-1024
Elektronisch ISSN: 1573-2843
DOI
https://doi.org/10.1007/s10826-017-0846-x

Andere artikelen Uitgave 12/2017

Journal of Child and Family Studies 12/2017 Naar de uitgave