Pediatric Mental Health Integration and Perceived Quality of Care

This study examined how access to behavioral and mental health (B/MH) professionals varied across general and subspecialty pediatricians and whether access to, and degree of, B/MH integration in clinical settings was associated with pediatricians' perceptions of health care quality and moral distress.

A voluntary survey was administered to pediatricians during enrollment in the 2022 American Board of Pediatrics Maintenance of Certification program. The survey assessed access to, and level of, integration with B/MH professionals in their clinical practice, perceived quality of care, and moral distress. Multivariable logistic regression estimated associations between constructs, adjusting for demographic and practice characteristics.

A total of 5321 respondents were included in this analysis (55.2% response rate). Overall, 68.3% (n = 3634) reported access to B/MH professionals in their primary clinical setting, most commonly a social worker (53.1%; n = 2825). Critical care pediatricians most frequently report access to B/MH professionals (97.9%; n = 279) compared with 55.4% of general pediatricians (n = 1797). Level of B/MH integration varied substantially across subspecialties. Availability of a B/MH professional was associated with a significantly lower odds of perceived suboptimal care quality (odds ratio, 0.78; 95% CI, 0.66-0.93) but was not significantly associated with moral distress in the full sample. Higher levels of integration were associated with lower odds of reporting suboptimal care, but not moral distress, except in a subspecialty subsample.

Many pediatricians' have access to a B/MH professional with varied degrees of integration. High levels of integration may improve perceptions of health care quality but may not ameliorate moral distress caring for children with B/MH conditions.