When Behavioral Health Concerns Present in Pediatric Primary Care: Factors Influencing Provider Decision-Making

Elizabeth H Connors; Prerna Arora; Angela M Blizzard; Kelly Bower; Kelly Coble; Joyce Harrison; David Pruitt; Janna Steinberg; Lawrence Wissow

doi:10.1007/s11414-017-9580-9

When Behavioral Health Concerns Present in Pediatric Primary Care: Factors Influencing Provider Decision-Making

J Behav Health Serv Res. 2018 Jul;45(3):340-355. doi: 10.1007/s11414-017-9580-9.

Authors

Elizabeth H Connors¹, Prerna Arora², Angela M Blizzard³, Kelly Bower⁴, Kelly Coble⁵, Joyce Harrison⁴, David Pruitt⁵, Janna Steinberg⁴, Lawrence Wissow⁴

Affiliations

¹ University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, 21201, USA. econnors@som.umaryland.edu.
² Pace University, One Pace Plaza, New York, NY, 10038, USA.
³ Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA.
⁴ Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
⁵ University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, 21201, USA.

PMID: 29209899
DOI: 10.1007/s11414-017-9580-9

Abstract

Primary care providers (PCPs) frequently encounter behavioral health (BH) needs among their pediatric patients. However, PCPs report variable training in and comfort with BH, and questions remain about how and when PCPs address pediatric BH needs. Existing literature on PCP decisions to address pediatric BH in-office versus referring to subspecialty BH is limited and findings are mixed. Accordingly, this study sought to examine parameters and contextual factors influencing PCP decisions and practices related to BH care. Qualitative interview results with 21 PCPs in Maryland indicated that decisions about how and when to address pediatric BH concerns are influenced by the type BH service needed, patient characteristics, the availability of BH services in the community, and possibly PCPs' perceptions of BH care as a distinct subspecialty. Findings suggest that efforts to support individual PCPs' capacity to address BH within primary care must be balanced by efforts to expand the subspecialty BH workforce.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Attitude of Health Personnel
Child
Decision Making*
Female
Health Knowledge, Attitudes, Practice*
Health Personnel / psychology*
Humans
Interviews as Topic
Male
Maryland
Mental Disorders / diagnosis
Mental Disorders / psychology*
Mental Disorders / therapy
Nurses / psychology
Pediatric Nurse Practitioners / psychology
Pediatricians / psychology
Pediatrics / methods*
Physicians, Primary Care
Practice Patterns, Physicians'
Primary Health Care / methods*
Referral and Consultation*
Rural Health Services
Urban Health Services