Behavioral and developmental problems of children in primary care: Opportunities for psychologists.

Identification and Management of Psychosocial and Developmental Problems in Community-Based, Primary Care Pediatric Practices

PEDIATRICS ◽

10.1542/peds.89.3.480 ◽

1992 ◽

Vol 89 (3) ◽

pp. 480-485 ◽

Cited By ~ 3

Author(s):

Sarah McCue Horwitz ◽

Philip J. Leaf ◽

John M. Leventhal ◽

Brian Forsyth ◽

Kathy Nixon Speechley

Keyword(s):

Primary Care ◽

Child Behavior Checklist ◽

Social Issues ◽

Young Patients ◽

Well Being ◽

World Health ◽

Developmental Problems ◽

Active Intervention ◽

Health Organization ◽

New Morbidity

The importance of psychological and social issues for children's well-being has long been recognized and their importance in the practice of pediatrics is well documented. However, many of the studies looking at this issue have emphasized psychiatric problems rather than issues commonly referred to as the new morbidity. The goal of this research was to refocus interest on the problems of the new morbidity. This study examined the rates and predictors of psychological problems in 19 of 23 randomly chosen pediatric practices in the greater New Haven area. Families of all 4- to 8-year-old children were invited to participate and to complete the Child Behavior Checklist prior to seeing a clinician. Clinicians completed a 13-category checklist of psychosocial and developmental problems based on a World Health Organization-sponsored primary care, child-oriented classification system. Of the 2006 eligible families, 1886 (94%) participated. Clinicians identified at least one psychosocial or developmental problem in 515 children (27.3%). Thirty-one percent of the children with problems received no active intervention, 40% received intervention by the clinician, and 16% were referred to specialty services. Not surprisingly, children whose problems were rated as moderate or severe were twice as likely to be referred compared with children with mild problems. Recognition of a problem was related to four characteristics: if the visit was for well child rather than acute care; if the clinician felt he or she knew a child well; if the child was male; and if the child had unmarried parents (all P ≤ .05). The data suggest that, when asked to use a taxonomy appropriate for primary care, clinicians recognize problems in many 4- to 8-year-old children (515/1886; 27.3%). This rate is considerably higher than the rates previously reported. Further, many children with identified problems (56%) were reported by their clinicians to receive some form of active intervention. Characteristics of the visit (type of visit, clinician's knowledge of a child) that influence the recognition of problems were also identified. These results suggest that investigators must define what types of problems they are interested in and under what circumstances to determine accurately what pediatric practitioners know about psychosocial and developmental problems in their young patients and families.

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Primary Care Approaches to Developmental Disabilities

PEDIATRICS ◽

10.1542/peds.64.4.506 ◽

1979 ◽

Vol 64 (4) ◽

pp. 506-514

Author(s):

Jack P. Shonkoff ◽

Paul H. Dworkin ◽

Alan Leviton ◽

Melvin D. Levine

Keyword(s):

Primary Care ◽

Developmental Disabilities ◽

New England ◽

Clinical Judgment ◽

Working Hours ◽

School Failure ◽

Learning Problems ◽

Developmental Assessment ◽

Developmental Problems ◽

Preschool Screening

Ninety-seven board certified pediatricians who spend at least 75% of their professional working hours involved in the delivery of primary care in New England were interviewed to explore their attitudes and current clinical approaches to developmental disabilities. The majority of the pediatricians relied exclusively on clinical judgment and general observations for assessing developmental problems in their offices. Responsibility for preschool screening for potential learning problems and the assessment of school failure were considered appropriate pediatric concerns. Reported customary approaches to a variety of developmental problems were not affected by the size of the practice nor by the socioeconomic status of the patient population. Patterns of referral for consultation appeared to be more dependent on the nature of the suspected disorder than on the characteristics of the physicians or their practices. The need for more rigorous training in the developmental aspects of child health has been emphasized. In order to meet this challenge, more precise techniques for pediatric developmental assessment and more conclusive evalutions of specific interventions will have to be produced.

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Screening for developmental problems at primary care level: a field programme in San Isidro, Argentina

Paediatric and Perinatal Epidemiology ◽

10.1111/j.1365-3016.2007.00897.x ◽

2008 ◽

Vol 22 (2) ◽

pp. 180-187 ◽

Cited By ~ 13

Author(s):

Horacio Lejarraga ◽

Ana Maria Menendez ◽

Enrique Menzano ◽

Lucìa Guerra ◽

Silvia Biancato ◽

...

Keyword(s):

Primary Care ◽

Care Level ◽

Primary Care Level ◽

Developmental Problems

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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