Parental disclosure of child psychosocial concerns: relationship to physician identification and management

Physician identification and management of psychosocial problems in children is related to parental disclosure. The purpose of this research was to evaluate a method of prompting parental disclosure of such problems and to determine the impact of parental disclosure on family physicians' identification of and intervention for childhood psychosocial problems.

Participants were parents and physicians of 60 children between the ages of 3 and 10 years attending an ambulatory care clinic of a community-based, university-affiliated family medicine training program. Parents completed the Child Behavior Checklist and also indicated whether psychosocial problems were discussed or managed. Physicians completed a checklist about the psychosocial status of the child and potential interventions for identified problems. One half of the participating parents formed the experimental group and were also asked to note their concerns on a Psychosocial Checklist for Children and to discuss these concerns with their child's physician; the other half of parents received no such checklist and acted as the control group. All interactions between parents and physicians were videotaped.

The number of parental psychosocial disclosures, but not the number of parents who disclosed them, was significantly higher for the experimental group. Physicians were three times as likely to identify a psychosocial problem and 10 times as likely to intervene when parents discussed psychosocial concerns.

Parents' disclosure of psychosocial concerns to their child's physician increases the likelihood of physicians identifying and intervening for these problems. The finding that physicians intervened for psychosocial problems even when they failed to record these problems suggests that research needs to focus on measuring both intervention and identification.