Enhancing the primary care pediatrician's role in managing psychosocial issues: a cross sectional study of pediatricians and parents in Israel

Abstract

Background Psychosocial issues are an integral part of children's health and well-being, and it is widely acknowledged that pediatricians should be involved in their management. We examined the current perception of the pediatrician’s role in the management of psychosocial problems in Israel from the perspective of parents and pediatricians, and identified possible barriers. Methods We assessed parents' and pediatricians' perspectives through a cross sectional survey. 1000 parents with children under 10 were randomly selected from a large database representing the Israeli population and phone-surveyed by a polling company. Due to a low response-rate (5.4%), there was an overrepresentation of married parents and underrepresentation of parents with primary or secondary education. 173 Pediatricians were recruited both at a medical conference and by a web-based questionnaire. Results 55% of the parents reported they were concerned with at least one psychosocial problem, yet less than 50% of them discussed these issues with the pediatrician. 59.9% of the parents did not perceive psychosocial problems as relevant to the pediatrician's role. Pediatricians with some previous training related to psychosocial issues were more likely to report on a lack of professional confidence (p = .037) and insufficient available resources (p = .022) as barriers to their involvement, while pediatricians who had no training were more likely to report on the parents' perception of their role as the barrier to involvement (p = .035). Conclusions Parents tend to avoid the discussion of psychosocial concerns in pediatric settings due to their perception that it's irrelevant to the pediatrician's role. Trained pediatricians feel unconfident in their ability to manage psychosocial issues and report on a lack of suitable resources. These findings suggest current pediatric mental-health training is insufficient to equip pediatricians with the knowledge and skills required to their involvement in psychosocial problems, and imply necessary changes to environment of community-based pediatrics. In order to change the practice of pediatricians in the community to enable them to address a variety of psychological issues, appropriate training is needed, through all stages of the pediatrician’s professional life, including medical school, pediatric residency and continuous medical education.

“I’m 'just' a community pediatrician” views and challenges of pediatricians working in the community in Israel

“…The survey results indicate that pediatricians have limited knowledge on a variety of developmental, behavioral and emotional issues. These findings complement those found in a previous study in Israel about pediatricians’ roles in management of psychosocial issues [ 9 ], and are supported by the qualitative results. Additionally, the qualitative results show that some pediatricians in the community adopt a more complex role, but the system (including training programs and HMOs) has not adapted nor supported this change.…”

“…The appropriate tools, skills and exposure required for community pediatric work [ 5 , 8 ] are inadequately provided. An Israeli study regarding the management of psychosocial issues found that many pediatricians who work in the community face psychosocial issues in their practice, without having the training, time or confidence to provide the support and treatment needed [ 9 ].…”

“…The Social and Cognitive Career Theory (SCCT) [19,20] emphasizes the barriers in professional development which may interfere with professional tendencies and achievement of professional goals, but which may also be a motivator for change and development [21,22]. For pediatricians who work in the community, these barriers may be related to changes in the profession, characteristics of the community, the work environment, or the physicians themselves [9]. In light of the unmet needs of children facing the 'new morbidities' and the ongoing changes in pediatrics in the community in Israel, the present study examines the professional identify of pediatricians in the community, in relation to the current definitions of community pediatrics, the barriers and challenges of their work and the ways in which they create changes in the field.…”

Reliability and validity of the Autism Screen for Kids and Youth

“…S. Sun et al, 2018; Voigt, 2022). In Israel, community pediatricians are responsible for referrals to specialist diagnostic teams, yet they have little involvement in detecting developmental-behavioral conditions (Nissanholtz-Gannot et al, 2021) and discussions of psychosocial issues are largely initiated by parents (Gadassi et al, 2022). Parents likely require assistance in adequately identifying and communicating their concerns to primary care doctors who can, in turn, benefit from potential areas of concern being highlighted to them in an efficient manner.…”