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Factors Related to Providers Screening Children for Behavioral Health Risks in Primary Care Settings
Lisa M Jones1, Kerry Nolte2, Alyssa J O'Brien2
1Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
Insights
Pediatric providers frequently screen for behavioral health risks like depression and anxiety. However, screening for social determinants of health varies, with limited resources impacting provider willingness to screen.
Area of Science:
- Pediatric Primary Care
- Behavioral Health Screening
- Social Determinants of Health
Background:
- Primary care settings are crucial for early identification of behavioral health issues in children.
- Screening practices for behavioral health risks among children vary significantly among providers.
Purpose of the Study:
- To investigate the current practices of pediatric and family medicine primary care providers in screening children for behavioral health risks.
- To identify factors influencing screening practices and referral rates.
Main Methods:
- A confidential online survey was administered to a sample of 319 physicians and 292 nurse practitioners across the U.S.
- The survey utilized computer-assisted self-interview to gather data on screening practices for various behavioral and social risks.
Main Results:
- Nearly all providers (89%) screen for depression, anxiety, and behavior problems.
- Screening for child substance use, family support, household changes, bullying, child abuse, and domestic violence was common, often using informal methods.
- Screening for caregiver mental health, substance use, financial strain, and transportation difficulties was less frequent.
- Screening was linked to higher referral rates and was more likely in practices with provider confidence, perceived community resources, and integrated care systems.
Conclusions:
- Significant diversity exists in how primary care providers screen for behavioral health and social risks.
- Limited availability of resources for addressing identified issues can lead to provider reluctance in screening.
- Further research is needed to establish optimal screening methods and contexts for social risks, supported by training and community resources.
Purpose:
To provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks.
Design And Methods:
Participants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview.
Results:
Almost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health.
Conclusions:
Findings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks.
Practice Implications:
Protocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.
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