Format

Send to

Choose Destination
See comment in PubMed Commons below
J Dev Behav Pediatr. 2013 Nov-Dec;34(9):680-7. doi: 10.1097/01.DBP.0000437831.04723.6f.

Pediatric provider processes for behavioral health screening, decision making, and referral in sites with colocated mental health services.

Author information

1
*Department of Medicine, Institute for Community Health, Cambridge Health Alliance, Harvard Medical School Cambridge, MA; †Department of Psychiatry, Division of Child and Adolescent Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; ‡Department of Pediatrics, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; §The Dimock Health Center, Roxbury, MA; ¶Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Abstract

OBJECTIVE:

Validated behavioral health (BH) screens are recommended for use at well-child visits. This study aimed to explore how pediatricians experience and use these screens for subsequent care decisions in primary care.

METHODS:

The study took place at 4 safety net health centers. Fourteen interviews were conducted with pediatricians who were mandated to use validated BH screens at well-child visits. Interview questions focused on key domains, including clinic BH context, screening processes, assessment of screening scores, and decision making about referral to mental health services. Qualitative analysis used the Framework Approach.

RESULTS:

A variety of themes emerged: BH screens were well accepted and valued for the way they facilitated discussion of mental health issues. However, screening results were not always used in the way that instrument designers intended. Providers' beliefs about the face validity of the instruments, and their observations about performance of instruments, led to discounting scored results. As a result, clinical decisions were made based on a variety of evidence, including individual item responses, parent or patient concerns, and perceived readiness for treatment. Additionally, providers, although interested in expanding their mental health discussions, perceived a lack of time and of their own skills to be major obstacles in this pursuit.

CONCLUSIONS:

Screens act as important prompts to stimulate discussion of BH problems, but their actual scored results play a variable role in problem identification and treatment decisions. Modifications to scheduling policies, additional provider training, and enhanced collaboration with mental health professionals could support better BH integration in pediatric primary care.

[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Lippincott Williams & Wilkins
    Loading ...
    Support Center