We propose a 5-year study of the extent to which pediatricians function as part of the mental health service system for children ages 4-8. Psychosocial problems in children incur substantial health care costs, impair performance in school, and cause considerable family strain. Pediatricians potentially play an important role in the treatment of psychological problems in this age group although the interface between the pediatrician's office and the mental health specialty sector is not well understood. Previous research suggests that pediatricians fail to identify many psychosocial problems in their patients and make only limited use of referrals to mental health specialists. The purposes of this study are to determine: (1) the extent to which pediatricians provide or serve as a referral agent for mental health related treatment for children ages 4-8; (2) the extent to which physician, patient, and family characteristics influence the detection of psychosocial problems; and (3) the outcomes associated with the identification of problems in children. To accomplish these purposes we shall: 1) Obtain a sample of pediatric practices in a 13-town area of South-Central Connecticut; 2) Select a stratified random sample of children ages 4-8 being seen by pediatricians in these practices; 3) Interview children, family members, pediatricians, and school personnel in order to identify psychosocial problems, treatment strategies, referral patterns, and factors influencing the identification of these problems; and 4) Reinterview subjects, pediatricians, family members, and school personnel at 12 and 24 months in order to study the correlates of management strategies and the detection and treatment of new and continuing psychosocial problems. This study will provide important information about psychosocial issues identified by pediatricians, treatment strategies used to manage these problems, and outcomes for children with psychosocial problems.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Yale University
Schools of Medicine
New Haven
United States
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Leaf, Philip J; Owens, Pamela L; Leventhal, John M et al. (2004) Pediatricians' training and identification and management of psychosocial problems. Clin Pediatr (Phila) 43:355-65
Briggs-Gowan, Margaret J; Owens, Pamela L; Schwab-Stone, Mary E et al. (2003) Persistence of psychiatric disorders in pediatric settings. J Am Acad Child Adolesc Psychiatry 42:1360-9
Kerker, B D; Horwitz, S M; Leventhal, J M et al. (2000) Identification of violence in the home: pediatric and parental reports. Arch Pediatr Adolesc Med 154:457-62
Briggs-Gowan, M J; Horwitz, S M; Schwab-Stone, M E et al. (2000) Mental health in pediatric settings: distribution of disorders and factors related to service use. J Am Acad Child Adolesc Psychiatry 39:841-9
Horwitz, S M; Leaf, P J; Leventhal, J M (1998) Identification of psychosocial problems in pediatric primary care: do family attitudes make a difference? Arch Pediatr Adolesc Med 152:367-71
Horwitz, S M; Bility, K M; Plichta, S B et al. (1998) Teacher assessments of children's behavioral disorders: demographic correlates. Am J Orthopsychiatry 68:117-25
Forsyth, B W; Horwitz, S M; Leventhal, J M et al. (1996) The child vulnerability scale: an instrument to measure parental perceptions of child vulnerability. J Pediatr Psychol 21:89-101
Burger, J; Horwitz, S M; Forsyth, B W et al. (1993) Psychological sequelae of medical complications during pregnancy. Pediatrics 91:566-71
Horwitz, S M; Leaf, P J; Leventhal, J M et al. (1992) Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics 89:480-5