Pediatric Primary Care Providers’ Relationships with Mental Health Care Providers: Survey Results
As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental health providers would differ in their care of patients with mental health concerns when compared to PPCPs not in such relationships.
To explore differences between PPCPs who have relationships with mental health care providers and those who do not with regard to their care of children with mental health concerns.
Seventy-two PPCPs completed a mailed survey addressing topics such as comfort levels diagnosing and managing patients with behavioral health disorders, perceived barriers to care, activity related to prescribing psychotropic medications, and availability of consultation with mental health specialists. More than one-third (19 providers) of providers reported no specialized training in behavioral pediatrics and nearly 45 % (32 providers) indicated having a relationship or partnership with a mental health specialist.
Those providers who reported relationships indicated greater availability of consultation and communication with psychiatric providers as well as telephone consultation with non-psychiatric mental health providers. All providers were more comfortable assessing as opposed to treating children with disorders, with the exception of attention disorders, which providers were comfortable with both treating and assessing. For all conditions, there was no main effect for partnership.
While partnerships may be associated with greater availability of consultation and communication, for this sample of PPCPs there was no evidence of advantage with respect to diagnosis and management. The paper concludes with a discussion of study limitations, the need for further research, and suggestions for practice.
KeywordsPediatric primary care Behavioral health Collaboration Partnership
We would like to thank the Child Health and Development Institute of Connecticut/The Children’s Fund of Connecticut for their generous funding of this project. We would also like to acknowledge Katherine A. Black, Ph.D. for her thoughtful reading and helpful comments with regard to the manuscript, and John Mehm, Ph.D for his willingness to discuss the survey and quantitative analyses. Finally, we would like to express our appreciation to all of the providers who contributed to this project by taking the time to complete the survey.
Conflict of interest
None of the authors has any conflict of interest to declare with respect to publication of this manuscript.
- American Academy of Pediatrics. (1992). Task force on the definition of the medical home. The medical home. Pediatrics, 90, 774.Google Scholar
- American Academy of Pediatrics. (2008). Recommendations for preventive pediatric health care. Retrieved from http://aappolicy.aappublications.org/cgi/reprint/pediatrics;120/6/1376.pdf. American Psychologist, 57(12), 1060–1073.
- American College of Physicians. (2010) The patient-centered medical home neighbor: The interface of the patient-centered medical home with specialty/subspecialty practices. A position paper of the American College of Physicians. Retrieved from http://www.acponline.org/advocacy/where_we_stand/policy/pcmh_neighbors.pdf.
- American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Washington, DC: American Psychological Association.Google Scholar
- An Act Relative to Children’s Mental Health, S. 2518. (2008). Retrieved from http://www.ctbhp.com/provider/bulletins/pb08_14.pdf/.
- Clay, R. A. (2012). Integrated care is the future. Monitor on Psychology, 43(5), 62–63.Google Scholar
- Connor, D. F., McLaughlin, T. J., Jeffers-Terry, M., O’Brien, W. H., Stille, C. J., Young, L. M., et al. (2006). Targeted child psychiatric services: A new model of pediatric primary clinician- child psychiatry collaborative care. Clinical Pediatric (Philadelphia), 45(5), 423–434.CrossRefGoogle Scholar
- Heflinger, C. A., & Hinshaw, S. P. (2010). Stigma in child and adolescent mental health services research: Understanding professional and institutional stigmatization of youth with mental health problems and their families. Administration and Policy in Mental Health, 37(1–2), 61–70.PubMedCrossRefGoogle Scholar
- Hilt, R., McDonell, M. G., Rockhill, C., Golombek, A., & Thompson, J. (2009, Winter). The partnership access line: Establishing an empirically based child psychiatry consultation program in Washington state. Emotional and Behavioral Disorders in Youth, 2, 9–12.Google Scholar
- Hilt, R. J., McDonnell, M. G., Thompson, J., Schaefer, K., Trupin, E. W., Myers, J., et al. (2010, October). Telephone consultations assisting primary care child mental health. Poster presentation at the meeting of the American Association of Child and Adolescent Psychiatry, New York.Google Scholar
- Honigfeld, L., & Nickel, M. (2010). Integrating behavioral health and primary care: Making it work in four practices in Connecticut. Impact series. Farmington, CT: Child Health and Development Institute of Connecticut.Google Scholar
- Institute of Medicine (U.S.) Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Google Scholar
- Malouin, R. A., & Merten, S. L. (2010). Measuring medical homes: Tools to evaluate the pediatric patient- and family-centered medical home. Retrieved from http://www.medicalhomeinfo.org/downloads/pdfs/MonographFINAL3.29.10.pdf.
- National Survey of Children’s Health. (2011). Health care access and utilization (survey section 4). Retrieved from http://nschdata.org/DataQuery/DataQueryResults.aspx/.
- Ogles, B. M., Dowell, K., Hatfield, D., Melendez, G., & Carlston, D. (2004). The Ohio Scales. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (3rd ed., Vol. 2, pp. 275–304). Hillsdale, NJ: Lawrence Earlbaum.Google Scholar
- Pidano, A. E. (2007). How primary care providers respond to children’s mental health needs: Strategies and barriers. Impact series. Farmington, CT: Child Health and Development Institute of Connecticut.Google Scholar
- Pidano, A. E., Marcaly, K. H., Ihde, K. M., Kurowski, E. C., & Whitcomb, J. M. (2011b). Connecticut’s enhanced care clinic initiative: Early return from pediatric-behavioral health partnerships. Families, Systems, & Health, 29(2), 138–143. doi: 10.1037/a0023474.
- Starkowski, M. P. (2008, March 1). Policy Transmittal Letter to the State of Connecticut, Department of Social Services 2008–06. Retrieved from http://www.ctbhp.com/provider/bulletins/pb08_14.pdf/.
- Stroul, B.A. (2011). Integrating mental health services into primary care settings: Summary of a special forum held at the 2006 Georgetown University Training Institutes. Retrieved from http://www.mockingbirdsociety.org/files/reference/Mental_Health_and_Foster_Care/integrating_mental_health_and_primary_care.pdf/.
- Van Landeghem, K., & Hess, C. A. (2005). Issue paper: Children’s mental health: An overview and key considerations for health system stakeholders. Children’s Mental Health. Retrieved from http://www.nihcm.org/childpub.html.
- Ward-Zimmerman, B., & Cannata, E. (2012). Partnering with pediatric primary care: Lessons learned through collaborative colocation. Professional Psychology: Research and Practice., 43(6), 596–605.Google Scholar
- Wertheimer, R., Croan, T., Moore, K. A., & Hair, E. C. (2003). Attending kindergarten and already behind: A statistical portrait of vulnerable young children. Child Trends, 20, 1–8.Google Scholar