When Behavioral Health Concerns Present in Pediatric Primary Care: Factors Influencing Provider Decision-Making

Abstract

Primary care providers (PCPs) frequently encounter behavioral health (BH) needs among their pediatric patients. However, PCPs report variable training in and comfort with BH, and questions remain about how and when PCPs address pediatric BH needs. Existing literature on PCP decisions to address pediatric BH in-office versus referring to subspecialty BH is limited and findings are mixed. Accordingly, this study sought to examine parameters and contextual factors influencing PCP decisions and practices related to BH care. Qualitative interview results with 21 PCPs in Maryland indicated that decisions about how and when to address pediatric BH concerns are influenced by the type BH service needed, patient characteristics, the availability of BH services in the community, and possibly PCPs' perceptions of BH care as a distinct subspecialty. Findings suggest that efforts to support individual PCPs' capacity to address BH within primary care must be balanced by efforts to expand the subspecialty BH workforce.

Training Residents in the Early Identification of Anxiety Disorders: Feasibility and Preliminary Efficacy of a Novel Training Program

“…Exploring these topics in a primary care visit may seem impossible in the very short time allotted, especially in light of other factors that influence clinical decision making. 6 To effectively address mental health problems, early career pediatricians need to feel confident that they can efficiently address what the conversation may yield if they bring the topic up.…”

“…[3][4][5] Anxiety is also one of the most common mental health conditions that pediatricians encounter in practice. 6,7 Despite advances in evidence-based treatments, a significant portion of anxious children do not receive clinical services. 8,9 Early identification of anxiety disorders in primary care settings is crucial to improving access to intervention services for clinically anxious youth.…”

“…This set of challenges offers an opportunity for collaboration between pediatric faculty and clinical psychologists, particularly with regard to improving the education of the next generation of pediatricians.Pediatricians play a vital role in providing needed services to children suffering from emotional disorders in general, including initially detecting problems, providing information, recommendations, treatment, and/ or referrals for families. 6,10 Pediatricians are particularly valuable in connecting families to treatments due to their expertise in developmentally appropriate behaviors in young children and access to mental health referral resources. 11,12 Eighty-six percent of children in the United States see a pediatrician or other medical professional at least once per year 13 and form long, trusting relationships with caregivers.…”

Identifying and Making Recommendations for Pediatric Anxiety Disorders in Primary Care Settings: A Video-Based Training

“…Pediatricians represent gateways to mental health services, as they detect problems and provide important assistance to families including information, treatment, recommendations, treatment, and/or referrals. 14 However, pediatricians often lack the training necessary to screen for, evaluate for, and treat anxiety disorders. 10 , 15 Studies suggest the majority of practicing pediatricians feel they lack the appropriate training in identifying and treating mental health problems.…”

YouthCHAT as a Primary Care E-Screening Tool for Mental Health Issues Among Te Tai Tokerau Youth: Protocol for a Co-Design Study

“…There are a number of MHB screening tools available [41], but it can be time-consuming to administer these and interpret the results [43], and not all screening tools are suitable for use in all clinical contexts [43,44]. Where MHB screening for youth does occur, rates of follow-up and service use remain low [42,44,45].…”