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Interactions between parents and pediatric primary care physicians about children's mental health
W T Garrison1, E N Bailey, J Garb
1Department of Psychology, Children's National Medical Center, Washington, DC 20010.
Insights
Pediatricians often miss opportunities to discuss child mental health concerns during well-child visits. Successful parent-physician communication about psychosocial issues is more common in private practices.
Area of Science:
- Pediatric Health
- Child Psychology
- Healthcare Communication
Background:
- Parent-physician communication is crucial for addressing children's psychosocial and mental health needs.
- Well-child visits are key opportunities for identifying and managing these concerns.
Purpose of the Study:
- To examine parent-physician interaction patterns regarding psychosocial concerns during well-child visits.
- To identify factors influencing the discussion and addressing of child mental health issues.
Main Methods:
- Observational study of 1,378 well-child visits across four pediatric clinics (public and private).
- Data collected on parent-stated psychosocial concerns, willingness to discuss, and physician actions.
Main Results:
- Parents raised psychosocial concerns in 327 visits; 37% were unwilling to discuss.
- Physicians failed to address concerns in 35% of visits where parents were willing.
- Successful interactions were 3x more frequent in private vs. public clinics.
- Referrals to mental health services were more likely for parent-infant relationship concerns, older children, and Medicaid families.
Conclusions:
- Significant gaps exist in addressing parental psychosocial concerns during pediatric visits.
- Practice setting (private vs. public) impacts parent-physician communication success.
- Targeted interventions may be needed to improve mental health support in pediatric care.
Abstract:
Interaction patterns between parents and pediatricians were examined during 1,378 well-child visits to four public and private pediatric clinics. During 327 visits, parents listed at least one psychosocial concern related to their child's mental health. At 37 percent of these visits, parents said they did not wish to discuss the concern with the physician. Physicians failed to address concerns during approximately 35 percent of visits at which parents were willing to discuss them. Successful parent-physician interactions were three times more frequent in private practices than in a public clinic; they were more likely when fewer concerns were stated and less likely when behavior problems were the concern. Parents concerned about the parent-infant relationship were four times more likely to be referred to outside mental health services, although these cases were relatively rare. Older children and families receiving Medicaid were also more likely to be referred to such services.