Maternal and Child Health Journal

, Volume 23, Issue 1, pp 61–71 | Cite as

Do Subspecialists Ask About and Refer Families with Psychosocial Concerns? A Comparison with General Pediatricians

  • Cori GreenEmail author
  • Ruth E. K. Stein
  • Amy Storfer-Isser
  • Andrew S. Garner
  • Bonnie D. Kerker
  • Moira Szilagyi
  • Kimberly E. Hoagwood
  • Sarah M. Horwitz


Objectives Calls for pediatricians to tend to children’s psychosocial concerns have existed for decades because they are known to negatively impact child health. Children with chronic illnesses frequently have child- and family-level psychosocial concerns that complicate the care provided by their pediatric subspecialists. This study compares pediatricians who exclusively practice general pediatrics with subspecialists regarding their inquiring/screening and referring for psychosocial concerns. Physician and practice characteristics associated with these behaviors were examined. Methods We conducted a cross-sectional study using the 2013 American Academy of Pediatrics Periodic Survey of Fellows. Respondents included 304 pediatricians who exclusively practice general pediatrics and 147 subspecialists. The primary analysis compared the current practices of generalists vs. subspecialists with regard to inquiring/screening and referring children with 10 different psychosocial concerns. Covariates included socio-demographics, practice characteristics, and training experiences. Weighted univariate, bivariate and multivariable analyses were performed. Results Less than half of all pediatricians in the sample reported routinely inquiring/screening for most psychosocial concerns, and 2/3 of subspecialists failed to routinely inquire/screen for most of these conditions. Pediatricians who practice general pediatrics exclusively were more likely to inquire/screen (incident rate ratio (IRR) 1.41, p < .05) and refer (IRR 1.59, p < .001) for a greater number of psychosocial concerns than subspecialists, after adjusting for provider and practice characteristics. Having attended a child or adolescent mental health (MH) lecture/conference in the past 2 years was also related to inquiring/screening (IRR 1.24, p < .05). Conclusions Pediatricians infrequently inquire/screen and refer psychosocial concerns, with subspecialists addressing these concerns even less frequently.


Mental health Psychosocial factors General pediatricians Subspecialists Developmental and behavioral pediatrics 


Author Contributions

CG drafted sections of this article, interpreted analyses of the data, and critically reviewed all drafts and is accountable for all aspects of the work. REKS participated in the development of the survey, drafted sections of this article, interpreted analyses of the data, critically reviewed all drafts and is accountable for all aspects of the work. AS-I conducted the analyses, drafted sections of the manuscript, critically reviewed all drafts and is accountable for all aspects of the work. ASG developed a portion of the survey, critically reviewed all drafts and is accountable for all aspects of the work. BDK critically reviewed all drafts and is accountable for all aspects of the work. MS developed a portion of the survey, critically reviewed all drafts and is accountable for all aspects of the work. KEH critically reviewed all drafts and is accountable for all aspects of the work. SMH participated in the development of the survey, interpreted analyses of the data, drafted sections of the article, critically reviewed all drafts, and is accountable for all aspects of the work.


American Academy of Pediatrics supported the survey on which this report is based. NIMH P30 MH09 0322 (PI K. Hoagwood) supported Dr. Horwitz, Dr. Storfer-Isser, and Dr. Hoagwood’s participation in this research.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Cori Green
    • 1
    • 8
    Email author
  • Ruth E. K. Stein
    • 2
  • Amy Storfer-Isser
    • 3
  • Andrew S. Garner
    • 4
  • Bonnie D. Kerker
    • 5
    • 6
  • Moira Szilagyi
    • 7
  • Kimberly E. Hoagwood
    • 5
  • Sarah M. Horwitz
    • 5
  1. 1.General Academic PediatricsWeill Cornell Medical College/NewYork Presbyterian HospitalNew YorkUSA
  2. 2.PediatricsAlbert Einstein College of Medicine/Children’s Hospital at MontefioreBronxUSA
  3. 3.Statistical Research ConsultantsSchaumburgUSA
  4. 4.Case Western Reserve UniversityClevelandUSA
  5. 5.New York University School of MedicineNew YorkUSA
  6. 6.Nathan Kline Institute for Psychiatric ResearchOrangeburgUSA
  7. 7.University of California at Los AngelesLos AngelesUSA
  8. 8.Department of PediatricsNewYork Presbyterian Hospital/Weill Cornell Medical CollegeNew YorkUSA

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