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Barriers to the Identification and Management of Psychosocial Problems: Changes From 2004 to 2013
Sarah McCue Horwitz1, Amy Storfer-Isser2, Bonnie D Kerker3
1Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
Insights
Pediatricians still face significant barriers to child mental health care, despite some improvements. Inadequate training and confidence in treating mental health issues remain key challenges, necessitating better developmental and behavioral pediatrics education.
Area of Science:
- Pediatric healthcare
- Child mental health
- Medical education
Background:
- Pediatricians report numerous challenges in addressing children's mental health (MH) needs.
- The American Academy of Pediatrics (AAP) has increased focus on child MH, but its effect on perceived barriers is unclear.
Purpose of the Study:
- To examine changes in perceived barriers and their correlates for pediatricians caring for children with MH problems between 2004 and 2013.
Main Methods:
- A comparative analysis of two periodic surveys of randomly selected AAP members (2004: n=832; 2013: n=594).
- Surveys assessed sociodemographics, practice characteristics, and seven barriers to identifying, treating, managing, and referring child/adolescent MH problems.
- Weighted descriptive and logistic regression analyses were used to account for nonresponse bias.
Main Results:
- Lack of training in treatment (∼66%) and confidence in counseling (∼60%) remained consistent barriers.
- Fewer pediatricians reported barriers related to identifying MH problems, diagnosing, medication treatment, reimbursement, and time in 2013 compared to 2004 (P < .01).
- The proportion of pediatricians endorsing 6 or 7 barriers decreased from 34% in 2004 to 26% in 2013 (P < .005). General pediatricians exclusively reported more barriers.
Conclusions:
- Despite a reduction in some reported barriers, most pediatricians perceive inadequate training and confidence in treating child MH issues, along with time constraints.
- Significant obstacles persist in pediatric mental healthcare delivery.
- Enhanced training in developmental and behavioral pediatrics is crucial to address these ongoing challenges.
Objective:
Pediatricians report many barriers to caring for children with mental health (MH) problems. The American Academy of Pediatrics (AAP) has focused attention on MH problems, but the impact on perceived barriers is unknown. We examined whether perceived barriers and their correlates changed from 2004 to 2013.
Methods:
In 2004, 832 (52%) of 1600 and in 2013, 594 (36.7%) of 1617 of randomly selected AAP members surveyed responded to periodic surveys, answering questions about sociodemographics, practice characteristics, and 7 barriers to identifying, treating/managing, and referring child/adolescent MH problems. To reduce nonresponse bias, weighted descriptive and logistic regression analyses were conducted.
Results:
Lack of training in treatment of child MH problems (∼66%) and lack of confidence treating children with counseling (∼60%) did not differ across surveys. Five barriers (lack of training in identifying MH problems, lack of confidence diagnosing, lack of confidence treating with medications, inadequate reimbursement, and lack of time) were less frequently endorsed in 2013 (all P < .01), although lack of time was still endorsed by 70% in 2013. In 2004, 34% of pediatricians endorsed 6 or 7 barriers compared to 26% in 2013 (P < .005). Practicing general pediatrics exclusively was associated with endorsing 6 or 7 barriers in both years (P < .001).
Conclusions:
Although fewer barriers were endorsed in 2013, most pediatricians believe that they have inadequate training in treating child MH problems, a lack of confidence to counsel children, and limited time for these problems. These findings suggest significant barriers still exist, highlighting the need for improved developmental and behavioral pediatrics training.
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