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

Abstract

Objective The objectives were to: assess the availability of on-site mental health professionals (MHP) in primary care; examine practice/pediatrician characteristics associated with on-site MHPs; and determine whether presence of on-site MHPs is related to pediatricians’ co-managing or more frequently identifying, treat/managing or referring MH problems. Methods Analyses included AAP members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (N=321). Measures included socio-demographics, practice characteristics, questions on about on-site MHPs, co-management 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/HMOs, <100 visits/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 co-location and co-management or whether pediatricians usually identified, treat/managed or referred 5 common child MH problems. Among the subset of pediatricians who reported co-managing there was an association with co-management when the on-site MHP was a child psychiatrist, SA 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 co-manage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, SA counselor, or social worker. Overall, on-site MHPs were not associated with co-management or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.

Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians

“…The findings of this survey may not be generalizable to family practitioners, nurse practitioners, or pediatricians that are not AAP members. However, response rates were consistent with other recent national surveys of physicians, 21,22 and the methodology was robust, including the use of response rate weights to account for non-response bias. 23 Furthermore, data from the American Board of Pediatrics estimates 61% of US boardcertified pediatricians ages 27 to 70 years are AAP members, suggesting AAP members do represent the majority of boardcertified pediatricians.…”

Which Pediatricians Comanage Mental Health Conditions?

“…However, the majority of pediatricians are still not managing or co-managing most common child MHCs. 4,5 …”

“…21 However, our prior study demonstrated that only a third of pediatricians reported co-managing at least half of their patients. 4 Co-management for MH care is understudied and we know little about what factors influence pediatricians to co-manage MHCs.…”

“…22 There is evidence that integrated models of care can impact providers’ behaviors and improve MH outcomes in some, but not all studies. 23 However, the presence of an on-site provider is still uncommon 4,24 and a national study of practicing pediatricians found no association between the presence of an onsite provider and treating or co-managing MHCs. 4 Therefore, it is important to explore other factors, beyond the physical presence of a MH provider, which influence co-management.…”

“…23 However, the presence of an on-site provider is still uncommon 4,24 and a national study of practicing pediatricians found no association between the presence of an onsite provider and treating or co-managing MHCs. 4 Therefore, it is important to explore other factors, beyond the physical presence of a MH provider, which influence co-management. The objective of this study is to investigate physician characteristics, practice characteristics, and training experiences that are associated with general pediatricians’ co-managing more than 50% of their patients with MHCs.…”