Impact of Pediatric Mental Health Screening on Clinical Discussion and Referral for Services

Jonovich, Sarah J.; Alpert-Gillis, Linda J.

doi:10.1177/0009922813511146

Cited by 7 publications

(7 citation statements)

References 18 publications

(23 reference statements)

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“…A second example consisted of a study of pediatric mental health screening which found referrals to increase 2.4 times over baseline [54]. To explore plausible parameter values that might explain this result, we first calibrated the model to reflect the 10.3% referral rate reported at baseline in the study by changing the rate at which FN were lost to follow-up from 73 to 80%.…”

Section: Resultsmentioning

confidence: 99%

“…For example, one trial that resulted in a very large increase in both identification and referrals (falling well beyond the range predicted by our model) also was the only study in our sample to focus on suicide [53]—an outcome for which physicians are likely to regret FNs far more than for other behavioral conditions. A separate trial that reported a very large change in referrals also included provision of significant mental health services in addition to screening [54], which our model predicts will influence decision thresholds. Thus, the model offers plausible hypotheses to explain heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

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A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

et al. 2016

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BackgroundClinical decision-making has been conceptualized as a sequence of two separate processes: assessment of patients’ functioning and application of a decision threshold to determine whether the evidence is sufficient to justify a given decision. A range of factors, including use of evidence-based screening instruments, has the potential to influence either or both processes. However, implementation studies seldom specify or assess the mechanism by which screening is hypothesized to influence clinical decision-making, thus limiting their ability to address unexpected findings regarding clinicians’ behavior. Building on prior theory and empirical evidence, we created a system dynamics (SD) model of how physicians’ clinical decisions are influenced by their assessments of patients and by factors that may influence decision thresholds, such as knowledge of past patient outcomes. Using developmental-behavioral disorders as a case example, we then explore how referral decisions may be influenced by changes in context. Specifically, we compare predictions from the SD model to published implementation trials of evidence-based screening to understand physicians’ management of positive screening results and changes in referral rates. We also conduct virtual experiments regarding the influence of a variety of interventions that may influence physicians’ thresholds, including improved access to co-located mental health care and improved feedback systems regarding patient outcomes.ResultsResults of the SD model were consistent with recent implementation trials. For example, the SD model suggests that if screening improves physicians’ accuracy of assessment without also influencing decision thresholds, then a significant proportion of children with positive screens will not be referred and the effect of screening implementation on referral rates will be modest—results that are consistent with a large proportion of published screening trials. Consistent with prior theory, virtual experiments suggest that physicians’ decision thresholds can be influenced and detection of disabilities improved by increasing access to referral sources and enhancing feedback regarding false negative cases.ConclusionsThe SD model of clinical decision-making offers a theoretically based framework to improve understanding of physicians’ behavior and the results of screening implementation trials. The SD model is also useful for initial testing of hypothesized strategies to increase detection of under-identified medical conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0517-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

et al. 2016

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“…Participants were recruited to the studies from a variety of settings including hospital emergency departments [42,43,45,48,51], schools [47,50,57], community [28,29,53e55] (through social media, local radio, community organisation, research company), and hospital clinics, outpatient clinics, and mental health services [44,46,49,52,56]. The interventions subsequently took place in an emergency department [42,43,48,51], over the phone [28,47,50], letter [57], online [55], in the community (sports club or school hall) [29,53,54], over the phone and/or in person (hospital clinic or mental health service) [45,46], and in hospital clinics, outpatient clinics, or mental health services [44,49,52,56].…”

Section: Characteristics Of the Interventionsmentioning

confidence: 99%

A Systematic Review of Help-Seeking Interventions for Parents of Adolescents

Murphy

Heary

Hennessy

et al. 2022

Journal of Adolescent Health

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Parents do not always seek timely help for adolescents when the need arises. Although interventions to increase parental help-seeking have been evaluated and published, no systematic review of these interventions has been conducted. The aim of this systematic review is to collate, synthesise, and evaluate research on help-seeking interventions for parents of adolescents. Methods: Six electronic databases were searched from inception to May 2020 using terms related to the concepts of "parent" and "help-seeking" and focusing on parents of adolescents (aged 10 e19 years). Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies; the Behavioural Change Taxonomy was used to code behavioral change techniques, and "promising interventions" were identified using pre-established criteria. Results: Eighteen studies met inclusion criteria, with six rated strong for design and methodology. The most frequently identified Behavioural Change Taxonomies included a credible source delivering the intervention, supporting parents, and providing prompts/cues regarding services/ appointments. Four interventions were identified as "promising" because of strong methodology, significant positive outcomes, and strong evidence-base. Conclusions: More high-quality, theory-driven parental help-seeking interventions using common outcome measures are needed to advance the literature in this area. Future research should replicate the promising interventions identified to develop best practice guidelines.

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“… Kazak and colleagues (2015) have published extensively on the use of the Psychosocial Assessment Tool (PAT 2.0), a screening tool based on this model, which has been used with a variety of pediatric populations including pediatric cancer, SCD, Congenital Heart Defects (CHD), diabetes, and organ transplant. There is emerging evidence that mental health screening in primary care settings may improve rates of referral to, and subsequent attendance at, psychiatric care appointments ( Jonovich & Alpert-Gillis, 2013 ). To our knowledge, there has not been any effort to translate this approach to neuropsychological service delivery.…”

Section: Public Health-based Models Of Assessment and Treatmentmentioning

confidence: 99%

Systematic Review: A Prevention-Based Model of Neuropsychological Assessment for Children With Medical Illness

Hardy

Olson

Cox

et al. 2017

Journal of Pediatric Psychology

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Abstract Objective Many pediatric chronic illnesses have shown increased survival rates, leading to greater focus on cognitive and psychosocial issues. Neuropsychological services have traditionally been provided only after significant changes in the child’s cognitive or adaptive functioning have occurred. This model of care is at odds with preventative health practice, including early identification and intervention of neuropsychological changes related to medical illness. We propose a tiered model of neuropsychological evaluation aiming to provide a preventative, risk-adapted level of assessment service to individuals with medical conditions impacting the central nervous system based on public health and clinical decision-making care models. Methods Elements of the proposed model have been used successfully in various pediatric medical populations. We summarize these studies in association with the proposed evaluative tiers in our model. Results and Conclusions This model serves to inform interventions through the various levels of assessment, driven by evidence of need at the individual level in real time.

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Impact of Pediatric Mental Health Screening on Clinical Discussion and Referral for Services

Abstract: Screening by parents improves detection of problems and fosters conversations with providers and subsequent connection with services.

Cited by 7 publications

References 18 publications

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

A Systematic Review of Help-Seeking Interventions for Parents of Adolescents

Systematic Review: A Prevention-Based Model of Neuropsychological Assessment for Children With Medical Illness

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