Search

BACKGROUND. 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. METHODS. 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. RESULTS. 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. CONCLUSIONS. 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. [ABSTRACT FROM AUTHOR]

BACKGROUND. Between 15% and 25% of children who visit primary care physicians have emotional, behavioral, or psychiatric problems that affect their functioning. The majority of these children are treated by primary care physicians. The purpose of this study was to examine the presentation and treatment of children's psychosocial problems in primary care and to investigate ways in which physician management of a problem is related to parent-physician agreement that the problem exists. METHODS. Twenty-six physicians at an ambulatory care center of a community-based, university-affiliated family medicine training program collected data during outpatient visits of 898 children aged 2 to 16 years. The physicians used a checklist to collect data on children's developmental problems, parents' concerns about the psychosocial functioning of their children, whether physicians and parents were in agreement about these concerns, and the parents' influence on physicians' management of the problems. RESULTS. Family physicians and parents agreed that 10% of the children were experiencing psychosocial problems. For 5% of children, physicians recorded emotional or behavioral concerns when parents did not disclose any such concerns. For only 1.8% of children, parents raised psychosocial concerns while physicians did not. Physicians diagnosed and managed psychosocial concerns during both acute-care and well-child visits. When parents and physicians agreed on the presence of pediatric psychosocial problems, referral to a mental health professional was more likely than when they disagreed (60% vs 16%). CONCLUSIONS. Pediatric psychosocial concerns are raised by parents during acute-care and well-child visits. Family physicians identified and managed these problems at rates consistent with past research. Management strategies appeared to differ as a function of agreement between physicians and parents on whether a problem existed. [ABSTRACT FROM AUTHOR]