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Identification of Youth Psychosocial Problems During Pediatric Primary Care Visits

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Abstract

This investigation applied the Gateway Provider Model (GPM) of child mental health services to investigate whether characteristics of the child, family, visit, and provider were related to the identification of youth psychosocial problems during primary care visits. Data were gathered during 774 visits to 54 primary care providers (PCPs) at 13 clinics. Similar to previous investigations in primary care settings, 42% of youth demonstrated at least a sub-threshold clinical mental health problem. Most PCPs reported high job satisfaction and control, but reported varying access to mental health specialists. PCPs generally had positive attitudes and beliefs about treating psychosocial problems but many reported that doing so was burdensome. Identification was more likely when the visit was for a mental health problem, when issues related to psychosocial problems were discussed during the visit, when the youth demonstrated mental health symptoms, impairment, or burden to the family, and when the youth was older, uninsured, or received Medicaid. Identification was less likely when the PCP reported greater burden associated with treating psychosocial problems and when the PCP reported greater accessibility to mental health specialists. These results suggest that identification is associated with the interaction of multilevel factors and that the GPM is a useful model to investigate points of intervention for improving the identification of children’s mental health problems in primary care settings.

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Acknowledgements

We are indebted to the families and providers of participating clinics. This analysis was supported by NIMH grant F31MH75531 (Dr. Brown). The original data collection was supported by NIMH grant R01MH62469 (Dr. Wissow). The data collection team included: Carmen Ivette Diaz, Mark Celio, O’Neil Costley, Lucia Martinez, Nancy Tallman, Alexandra Suchman, Nancy Weissflog, and Ciara Zachary. We thank Bernice Pescosolido, PhD (Indiana University) and Anne Gadomksi, MD, MPH (Bassett Research Institute) for their thoughtful guidance. We also thank the two anonymous reviewers for their improvement of this manuscript.

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Correspondence to Jonathan D. Brown.

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Presented in part at the University of South Florida 18th Annual Research Conference: A System of Care for Children’s Mental Health, Tampa, FL, February 2006.

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Brown, J.D., Riley, A.W. & Wissow, L.S. Identification of Youth Psychosocial Problems During Pediatric Primary Care Visits. Adm Policy Ment Health 34, 269–281 (2007). https://doi.org/10.1007/s10488-006-0106-7

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