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Introduction: Pediatric primary care providers (PPCPs) play an increasingly important role in addressing mental health concerns. Yet PPCPs are limited in the services they can provide because of constraints in training, time, and reimbursement. Whereas some patients may be appropriately treated in primary care, others require referrals to mental health specialists. The current study evaluated patient, clinician, and situational factors associated with PPCPS' reported likelihood to refer hypothetical patients with mental health concerns to mental health specialists. Method: The sample included 106 PPCPs from Massachusetts and Indiana who read one of two vignettes of hypothetical patients (one with symptoms of attention-deficit hyperactivity disorder (ADHD) and one with symptoms of depression) and then completed surveys regarding patient diagnosis and treatment decisions. Results: Results indicated that PPCPs who read the depression vignette were significantly more likely to report intentions to refer the patient to a mental health specialist than those who read the ADHD vignette as were PPCPs with less confidence in treating mental health concerns. PPCPs who read the depression vignette were also more likely to report intentions to refer to psychologists and social workers as opposed to PPCPs who read the ADHD vignette, who reported intentions to refer to psychiatrists. Training in developmental and behavioral pediatrics was not related to reported likelihood of referring. Conclusion: These findings illuminate potential areas for future research on referral patterns from primary care to mental health specialists. Keywords: pediatric primary care, mental health, referral, Pediatric primary care providers (PPCPs) play an increasingly important role in addressing mental health issues (Olfson, Blanco, Wang, Laje, & Correll, 2014). Limited training, time, and reimbursement influence PPCPs' capacity [...]

Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental health providers would differ in their care of patients with mental health concerns when compared to PPCPs not in such relationships. Objective: To explore differences between PPCPs who have relationships with mental health care providers and those who do not with regard to their care of children with mental health concerns. Methods: Seventy-two PPCPs completed a mailed survey addressing topics such as comfort levels diagnosing and managing patients with behavioral health disorders, perceived barriers to care, activity related to prescribing psychotropic medications, and availability of consultation with mental health specialists. More than one-third (19 providers) of providers reported no specialized training in behavioral pediatrics and nearly 45% (32 providers) indicated having a relationship or partnership with a mental health specialist. Results: Those providers who reported relationships indicated greater availability of consultation and communication with psychiatric providers as well as telephone consultation with non-psychiatric mental health providers. All providers were more comfortable assessing as opposed to treating children with disorders, with the exception of attention disorders, which providers were comfortable with both treating and assessing. For all conditions, there was no main effect for partnership. Conclusion: While partnerships may be associated with greater availability of consultation and communication, for this sample of PPCPs there was no evidence of advantage with respect to diagnosis and management. The paper concludes with a discussion of study limitations, the need for further research, and suggestions for practice.

Use of formal developmental screening tools in the pediatric medical home improves early identification of children with developmental delays and disorders, including Autism Spectrum Disorders. A pilot study evaluated the impact of an academic detailing module in which trainers visited 43 pediatric primary care practices to provide education about implementing developmental screening tools in well-child services. Attendees responded to a post presentation survey stating that they planned to implement screening in their practices. Medicaid billing data showed an increase in the state's overall rate of screening. An audit of medical charts in five practices that received the training and five that did not showed higher screening rates in practices that received the training as well as higher rates after the training than before. These pilot study results indicate the potential of academic detailing as an effective strategy for improving rates of developmental screening.

Neonatal Abstinence Syndrome Comprehensive Education and Needs Training (NASCENT) is a statewide, multi-stakeholder project created to respond to neonatal abstinence syndrome. The project demonstrated that a regional approach to education is an effective method to create awareness of the problem and knowledge of solutions. NASCENT demonstrated large improvements in both general and clinical knowledge across the three training program modules in the initial roll-out of NASCENT in north-central Connecticut. Eighty-three percent (83%) of providers who completed the evaluations (n = 1192) would change their practice. Eighty-four percent (84%) of providers indicated that there were risk management interventions that could be implemented in their practice. Eighty-seven percent (87.3%) indicated that the information presented was useful. Forty office practices trained 177 providers and staff, and 86% reported that they intended to use the information presented. The lack of time to use the information was the most frequently cited barrier (21%). [ABSTRACT FROM AUTHOR]

Abstract. Although dramatic gains have been realized in lowering the incidence of neonatal deaths among native American infants to a level lower than the white race, postneonatal death rates for this population remain twice as high as in the white race. The limited data available reveal that excessive postneonatal deaths among native American infants largely result from preventable accidents and treatable acute medical conditions, such as pneumonia and gastroenteritis. This suggests that native American infants leave the hospital healthy but go to unsafe environments, which decrease their chances of survival past I year. In particular, the poorer socioeconomic conditions that native American families experience and the related problems of alcoholism, unemployment, and family disorganization contribute to the high rate of postneonatal mortality. Intervention programs to lower native American postneonatal mortality should focus on promoting prompt recognition of and health seeking for treatable medical conditions and prevention of accidents and other postneonatal health problems. The roots of the problem of native American postneonatal mortality lie in the socioeconomic conditions of many Indian communities and cannot be addressed without recognition of how these factors combine with the health care delivery system to diminish life expectancy for native American infants. Pediatrics 1987; 80:575-578; native American infant, postneonatal mortality. [ABSTRACT FROM AUTHOR]