Barriers and facilitators of adolescent behavioral health in primary care: Perceptions of primary care providers.

Abstract

Several major policy reports describe the central role of primary care in improving the delivery of behavioral health care services to children and adolescents. Although primary care providers are uniquely positioned to provide these services, numerous obstacles hinder the integration of these services, including time, clinic management and organization issues, training, and resources. Although many of these obstacles have been described in the literature, few studies have investigated these issues from the first-person perspective of front-line providers. The purpose of this study, therefore, is to provide an in-depth description of primary care providers' attitudes and perceptions of adolescent behavioral health care across a diversity of primary care settings (i.e., Federally Qualified Health Center [FQHC], FQHC-Look Alike, school-based, military). Sixteen focus groups were conducted at 5 primary care clinics. Thematic analysis was used to analyze the focus group data. Obstacles to integration are presented as well as strategies to overcome these challenges, using training and education, working groups, and community collaboratives.

Childhood Emotional Abuse, Cruel Physical Punishment, and Anxiety among Adolescent Primary Care Patients

“…Recent data suggest that detection rates of psychiatric problems in primary care are increasing (Kelleher, McInerny, Gardner, Childs, & Wasserman, 2000); despite increasing rates of detection, there remains a substantial gap between the number of children who need mental health services and those who actually receive proper care. Adolescence is a developmental stage that provides an opportunity for prevention because many adolescents are initially presenting behavioral health issues and at-risk behaviors (both diagnostic and subdiagnostic) in primary care settings (Bitar et al, 2009); it is important that practitioners in these setting are able to identify contributing factors (i.e., emotional abuse, cruel physical punishment) and refer adolescent patients to additional resources for themselves and their families.…”

“…Although many adolescents may not meet the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders text revision (American Psychiatric Association, 2000), clinicians and primary care researchers recognize the importance of addressing needs for subdiagnostic mental health problems (Shrier, Harris, Kurland, & Knight, 2003). Youth with subdiagnostic behavioral health problems are likely to initially present these issues to primary care facilities and it is important that practitioners are able to recognize presenting behavioral health issues (Bitar, Springer, Gee, Graff, & Schydlower, 2009). Adolescents in primary care are at higher risk for mental health disorders, such as depression, compared to the general population, and, within a sample of adolescent primary care patients, those with histories of emotional abuse and harsh punishment were associated with elevated risk for depression and hopelessness (Courtney, Johnson, & Alloy, 2008;Johnson, Harris, Spitzer, & Williams, 2002).…”

Inter professional teamwork: A case study examining the practice patterns and perceptions of pediatric psychologists

“…Psychologists also noted that flexibility in clinic flow allowed for greater efficiency in patient care. Inefficiencies in clinic management and organization have been noted as barriers to integrated care by other authors as well [20].…”

“…Psychologists highlighted the use of standardized screening for behavioral health issues and appropriate triaging of cases as important to successful IPTs, a role that has been previously identified as critical for both effective care integration and early identification of psychosocial issues compromising health outcomes [20,21]. As experts in the interplay of biopsychosocial factors, this is a unique contribution that pediatric psychologists can make to the interprofessional team's repertoire of patient care tools.…”

Further Consideration of Systems, Stigma, Trauma, and Access to Care

“…Children with mental illness are subject to negative stereotypes and discrimination towards themselves and their families (Mukolo, Heflinger & Wallston, 2010). Public stigma also reduces the likelihood for adults and children to be referred for mental health care by physicians and other helping professionals (Bitar et al, 2009), and for parents to report shared decision-making with their child's primary medical provider related to the need for mental health care (Butler, 2014). Ms. Z's initial reluctance to enroll her children in mental health care can be understood as an awareness of potential for discrimination and rejection for both her daughters and for herself as a mother.…”