Background: Community surveys find that from 15-20 percent of school-age children have one or more mental health conditions sufficiently severe to warrant treatment. Even where specialty mental health consultation is available, a substantial proportion of children's mental health problems are identified and treated by generalists. Though many generalist providers are strongly committed to treating mental health problems, evaluations suggest that anywhere from 15 to 40 percent of children identified by generalists get no treatment. Training programs for generalists treating adults show that mental health care can be improved, but these studies have yet to be translated into pediatric settings. Advances in the conceptualization of psychotherapeutic techniques, and evolving knowledge about training physicians in communication skills, provide a strong background on which to base an intervention for pediatricians and family physicians. Methods: Quasi-experimental clinical trial of a two-session, highly interactive, training program involving simulated patients and personalized, structured feedback and analysis of psychosocial skills. The training program is based on a transtheoretical model of psychotherapuetic process, and includes skills related to engaging parents and children, problem identification, solution-focused therapy, and using motivational interviewing to make effective mental health referrals. Population and setting: Approximately 50 mid-career pediatricians and family physicians; approximately 350 children ages 5-17 and their mothers. Two regional, multi-site, multi-specialty staff model practices providing capitated and fee for service care to urban, suburban, and rural populations. Outcome measures: Improvement in child mental health symptoms and functioning (over a 6 month period) measured by a standardized instrument (the Strengths and Difficulties Questionnaire); changes in utilization of pediatric services; utilization of community services; measures of mothers' emotional well-being and of family function.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH062469-04
Application #
6911757
Study Section
Special Emphasis Panel (ZMH1-CRB-J (01))
Program Officer
Moten, Carmen P
Project Start
2002-07-01
Project End
2008-06-30
Budget Start
2005-07-01
Budget End
2008-06-30
Support Year
4
Fiscal Year
2005
Total Cost
$430,747
Indirect Cost
Name
Johns Hopkins University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Wissow, Lawrence; Gadomski, Anne; Roter, Debra et al. (2011) Aspects of mental health communication skills training that predict parent and child outcomes in pediatric primary care. Patient Educ Couns 82:226-32
Gadomski, Anne; Wissow, Lawrence S; Slade, Eric et al. (2010) Training clinicians in mental health communication skills: impact on primary care utilization. Acad Pediatr 10:346-52
Brown, Jonathan D; Wissow, Lawrence S (2010) Screening to identify mental health problems in pediatric primary care: considerations for practice. Int J Psychiatry Med 40:1-19
Brown, Jonathan D; Wissow, Lawrence S (2009) Discussion of sensitive health topics with youth during primary care visits: relationship to youth perceptions of care. J Adolesc Health 44:48-54
Brown, Jonathan D; Wissow, Lawrence S (2008) Disagreement in parent and primary care provider reports of mental health counseling. Pediatrics 122:1204-11
Wissow, Larry; Anthony, Bruno; Brown, Jonathan et al. (2008) A common factors approach to improving the mental health capacity of pediatric primary care. Adm Policy Ment Health 35:305-18
Wissow, Lawrence Sagin; Gadomski, Anne; Roter, Debra et al. (2008) Improving child and parent mental health in primary care: a cluster-randomized trial of communication skills training. Pediatrics 121:266-75
Wissow, Lawrence S; Erby, Lori Hamby (2008) Misunderstanding about communication. Arch Pediatr Adolesc Med 162:280-1
Brown, Jonathan D; Wissow, Lawrence S (2008) Discussion of maternal stress during pediatric primary care visits. Ambul Pediatr 8:368-74
Kemper, Kathi J; Foy, Jane M; Wissow, Larry et al. (2008) Enhancing communication skills for pediatric visits through on-line training using video demonstrations. BMC Med Educ 8:8

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