Introduction

Abstract

It is estimated that 13%-22% of the pediatric population has some type of behavioral or emotional problem. The prevalence is doubled in lower socioeconomic status households. In fact, 70% to 80% of parents have a behavioral concern when they visit their child’s physician for routine or acute care and the vast majority will not bring these concerns up unless they are solicited. It is estimated that 90% of mothers of 2- to 4-year-old children have “some” concern about their child’s behavior; 20% of mothers of 4-year olds have significant concerns. Unfortunately, primary care physicians (PCPs) have not been especially effective in detecting such problems, the sensitivity rate being 4%-7%. Interestingly, the strongest predictor of whether PCPs will detect a given behavioral problem is familiarity with the patient, or, more specifically, continuity of care (Kelleher et al., 1997; Kelleher & Wolraich, 1996). Without doubt, this becomes increasingly difficult in today’s healthcare environment.