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Psychosocial problems during child health supervision visits: eliciting, then what?
L Sharp1, R H Pantell, L O Murphy
1Department of Counseling, Sonoma State University, Rohnert Park, CA.
Insights
Pediatricians often create opportunities for discussing child psychosocial concerns during visits, but frequently fail to provide adequate guidance. Most physicians explored issues without offering information or reassurance, highlighting a gap in addressing children's mental health needs.
Area of Science:
- Child Health
- Pediatrics
- Psychosocial Health
Background:
- Child health supervision visits aim to address psychosocial issues in children and families.
- Understanding parent and child expression of concerns and physician responses is crucial.
Purpose of the Study:
- To assess opportunities for expressing psychosocial concerns during child health visits.
- To analyze the nature of physicians' responses to these concerns.
Main Methods:
- Analysis of videotaped child health supervision visits (34 children, aged 5-12).
- Development of coding systems for concern expression, psychosocial problem categories, and physician responses.
- Assessment of 34 pediatric and family medicine residents' interactions.
Main Results:
- Physicians created opportunities for discussion in 88% of visits; parents/children raised concerns in half.
- Common concerns included conduct/behavior problems (47%), insecurity (13%), and family/social issues (13%).
- Physicians largely responded with further questions (43%) or ignored concerns (17%), with limited psychosocial information/action (27%).
Conclusions:
- While opportunities for discussing psychosocial concerns exist, physicians often provide insufficient guidance and support.
- Pediatric residents showed a tendency to respond more to disruptive behavioral concerns.
- There is a need to improve physician communication and intervention strategies for pediatric psychosocial issues.
Abstract:
An explicit goal of child health supervision visits is to gather information and provide guidance about the psychosocial problems of children and families. The purpose of this study was to determine the extent to which parents had opportunities to express psychosocial concerns and the nature of physicians' responses to these concerns during health supervision visits. The authors analyzed videotapes of child health supervision visits by 34 children aged 5-12 years to 34 pediatric and family medicine residents. Coding systems with acceptable interobserver reliability were developed to assess (1) the nature of opportunities provided to express concerns, (2) categories of psychosocial problems expressed by parents and children, and (3) the nature of physicians' responses. In 88% of the child health supervision visits, opportunities were created by the physician to discuss psychosocial concerns or were spontaneously raised by the parent or child. In half of the visits, parents or children expressed a total of 30 psychosocial concerns. Psychosocial problems raised included conduct/behavior problems (47%), insecurity (13%), family, sibling, or social problems (13%), learning difficulties (10%), somatization (7%), and other (10%). Physicians' responses to these psychosocial concerns were as follows: 17% ignored the concern; 43% asked further exploratory questions but provided no information, reassurance, or guidance; 3% reassured the parent; 27% responded with psychosocial information and/or action; 3% responded with medical information and/or action; and 7% responded with a combination of these latter two modes of actions. Pediatric residents were more likely to respond to more disruptive behavioral concerns (r = .60, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)