School-based health centers (SBHC) have substantial potential to improve the recognition and treatment of adolescents' mental health problems. This study was undertaken as a quality improvement project to evaluate utility of the Pediatric Symptom Checklist when completed by youth (PSC-Y) among 383 adolescents seen at a SBHC, and the extent to which identification of psychosocial dysfunction and referral to mental health services improved academic functioning. Adolescents identified by the PSC-Y were significantly more likely to be insured by Medicaid, be a teen-age parent, and to have higher rates of absenteeism and tardiness in comparison to those not identified. Adolescents identified with the PSC-Y who were referred to mental health services significantly decreased their rates of absences and tardiness. Study results provide support for the utility of psychosocial screening and referral in the SBHC environment in facilitating recognition and treatment of adolescent mental health problems and improving student academic functioning.Psychosocial dysfunction, recognized 20 years ago as the "new morbidity" in pediatric practice, now represents the leading cause of disability in childhood and adolescence. 1,2 Epidemiological research estimates that 14%-20% of American children have one or more psychiatric disorders in the moderate to severe range. 3,5 Poor and minority children face an even greater risk. [6][7][8] Numerous studies have shown that untreated mental health problems can develop into more severe psychosocial impairment as children move into adolescence, placing them at risk for school drop-out and increased use of health care service. 9,10 The federal government, the Bureau of Maternal and Child Health, the American Academy of Pediatrics, and the American Medical Association all set standards for early identification and treatment of childhood and adolescent mental disorders. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptDespite the high prevalence of emotional and behavioral problems, and mandates from heath care and the federal government, only one-sixth to one-half of children and adolescents with psychosocial dysfunction are identified. Of these, only one-fifth receive mental health services. 2 Given these discouraging figures, at least some progress has been made with the development of screening questionnaires to increase identification of psychosocial dysfunction in children. The Pediatric Symptom Checklist (PSC) is a 35-item questionnaire designed to detect psychosocial problems in school-aged children. 11,12 Studies using the PSC in a broad range of pediatric settings and populations have shown that use of a brief, parent-completed screening measure greatly improves physician recognition of children's psychosocial problems. [13][14][15]
The World Health Organization has designated the teaching of otitis media management skills a "priority" status. Effective treatment of ear disease requires that the physician be both informationally educated as well as physically trained to use otoscopy. Little is known about how well this education can be provided in a short time and in a foreign country. To more objectively assess teaching effect, results of an education session for rural Mexican pediatric primary-care providers who were given an intensive otitis media lecture and otoscopy skills workshop in 1990 were evaluated. To test immediate cognitive impact, an anonymous written examination was given both before and after the teaching session. Average test scores after the educational sessions improved 24% (p < 0.001) over baseline scores before the sessions. To evaluate long-term impact on clinical practice, a follow-up telephone survey 2 years later was conducted. The use of an otoscope to diagnose otitis media had increased from 40% to 93% of respondents. We conclude that pediatric primary-care providers in rural Mexico possess a baseline level of knowledge about otitis media that can be significantly enhanced with one educational session. Further, this teaching effort produces an impact on practice pattern that lasts at least 2 years.
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