Do On-Site Mental Health Professionals Change Pediatricians' Responses to Children's Mental Health Problems?

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• 作者：Sarah McCue Horwitz ; PhD^a ; ^{Sarah.horwitz@nyumc.org" class="auth_mail" title="E-mail the corresponding author} ; Amy Storfer-Isser ; PhD^b ; Bonnie D. Kerker ; PhD^a ; ^c ; Moira Szilagyi ; MD ; PhD^d ; Andrew S. Garner ; MD ; PhD^e ; Karen G. O'Connor ; BS^f ; Kimberly E. Hoagwood ; PhD^a ; Cori M. Green ; MD ; MSc^g ; Jane M. Foy ; MD^h ; Ruth E.K. Stein ; MDⁱ
• 关键词：child psychosocial problems ; on-site mental health ; primary care
• 刊名：Academic Pediatrics
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：16
• 期：7
• 页码：676-683
• 全文大小：176 K

文摘

To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems.

Methods

Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed.

Results

Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, <100 visits per week, <80% of patients privately insured) and interactions of practice location (urban) with visits and patient insurance were associated with on-site MHPs. There was no overall association between colocation and comanagement, or whether pediatricians usually identified, treated/managed, or referred 5 common child MH problems. Among the subset of pediatricians who reported comanaging, there was an association with comanagement when the on-site MHP was a child psychiatrist, substance abuse counselor, or social worker.

Conclusions

On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.