Lost in Translation: Identifying Behavioral Health Disparities in Pediatric Primary Care

Abstract

Although care within a medical home increases parental satisfaction with health care services and improves health care utilization, significant racial/ethnic and language disparities persist in health care settings. Integrated, team-based approaches can decrease health disparities. The current study examines medical records of 2,353 youth who received a behavioral health consultation in an urban, residency training pediatric primary care clinic. A three-phase, mixed-method approach was used to examine whether differences in clinician-identified presenting concerns and recommendations were present across English-, Spanish-, and Other-language-speaking families. Findings reveal disparities among language groups in presenting concerns and referral to behavioral health services. Factors in medical record documentation also differed across language groups and by provider type. Recommendations for further research, identification, and assessment of psychosocial concerns for families with limited English proficiency (LEP) and development of evidence-based approaches for families with LEP in primary care are discussed.

Integrated Primary Medical-Behavioral Health Care for Adolescent and Young Adult Depression: Predictors of Service Use in the Youth Partners in Care Trial

“…However, Spanish-speaking clinicians were available in the YPIC study, extensive training on cultural factors aimed at enhancing clinician cultural sensitivity was provided, and telephone outreach was used when patients were unable to attend the clinics. Our findings, therefore, underscore the challenges and need for novel strategies to identify and address other factors that may be deterring service use among less acculturated families (Becker Herbst, Margolis, Millar, Muther, & Talmi, 2016).…”

The Scope of Behavioral Health Integration in a Pediatric Primary Care Setting

“…Furthermore, research has shown that integrated behavioral health in primary care helps reduce health disparities in ethnically and racially diverse populations, especially in the areas of identification of mental health or developmental concerns and the connection of families to necessary external services (Becker Herbst et al, 2016). This literature supports the need for additional research examining differences in how various ethnic/racial groups access, use, and are impacted by integrated behavioral health services.…”

“…Additionally, pediatric psychologists in integrated practice can delineate the specific requirements necessary to build workforce capacity to adequately meet the demand for behavioral health in pediatric primary care. Recognizing the importance and success of integrated behavioral health in primary care, increasing attention has been paid to building a competent workforce that is able to practice effectively as a part of the multidisciplinary primary care medical team Becker Herbst, Margolis, Millar, Muther, & Talmi, 2016) and meet the complex needs of diverse populations.…”

“…Additionally, although BHCs are trained to complete their flowsheets using a manual that describes all of the categories and response choices, documentation of clinical information is always subject to clinical judgment and will likely vary across BHCs. Finally, although efforts are made to recruit Spanish-speaking BHCs, the capacity to serve non-English speaking populations is limited (Becker Herbst et al, 2016) and is reflected in the demographic differences (i.e., higher prevalence of non-Latino Whites receiving integrated behavioral health services) seen across consultation types. Fortunately, the clinic has access to on-site interpreters and uses a phone interpretation service as needed to engage with children and families whose primary language is not English or prefer to receive services in another language.…”

Utilization of Integrated and Colocated Behavioral Health Models in Pediatric Primary Care

“…[1][2][3] Ethnic minority youth and youth in poverty are at a higher risk of mental health problems, yet are even less likely to receive behavioral health treatment than youth overall. 1,[3][4][5] In recent decades, the placement of behavioral health providers (eg, psychologists, psychiatrists, counselors, and clinical social workers) within the primary care setting has been explored as a method of increasing access to pediatric mental and behavioral health services. 6,7 The American Academy of Pediatrics recommends 12 wellchild visits to the primary care provider (PCP) by the age of 3 years, followed by annual visits until age 21 years.…”