Do Subspecialists Ask About and Refer Families with Psychosocial Concerns? A Comparison with General Pediatricians
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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.
KeywordsMental health Psychosocial factors General pediatricians Subspecialists Developmental and behavioral pediatrics
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.
- Accreditation Council for Graduate Medical Education. (2016). ACGME program requirements for graduate medical education in pediatrics. Retrieved March 26, 2018, from http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_pediatrics_2017-07-01.pdf?ver=2017-06-30-083432-507.
- Alisic, E., Hoysted, C., Kassam-Adams, N., Landolt, M. A., Curtis, S., Kharbanda, A. B., … Pediatric Emergency Research Canada (PERC). (2016). Psychosocial care for injured children: Worldwide survey among hospital emergency department staff. Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2015.10.067.Google Scholar
- American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health. (1982). Pediatrics and the psychosocial aspects of child and family health. Pediatrics, 70(1), 126–127.Google Scholar
- American Academy of Pediatrics Department of Research. (2017). Percent of AAP members who are women increases from 28 to 63% over 30 years. American Academy of Pediatrics News. Retrieved May 26, 2018, from http://www.aappublications.org/news/2017/09/06/Research090617.
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.CrossRefGoogle Scholar
- Garner, A. S., Shonkoff, J. P., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: Translating developmental science into lifelong health. Pediatrics, 129(1), e224–e231. https://doi.org/10.1542/peds.2011-2662.CrossRefGoogle Scholar
- Garner, A. S., Storfer-Isser, A., Szilagyi, M., Stein, R. E., Green, C. M., Kerker, B. D., & McCue Horwitz, S. (2016). Promoting early brain and child development: Perceived barriers and the utilization of resources to address them. Academic Pediatrics. https://doi.org/10.1016/j.acap.2016.11.013.Google Scholar
- Hagan, J., Shaw, J., & Duncan, P. (2008). Bright futures: Guidelines for health supervision of infants, children, and adoelscents (4th edn.). Illinois: Elk Grove Vilage.Google Scholar
- Haggerty, R. J. (1974). The changing role of the pediatrician in child health care. American Journal of Diseases of Children, 127(4), 545–549.Google Scholar
- Kazak, A. E., Hwang, W. T., Chen, F. F., Askins, M. A., Carlson, O., Argueta-Ortiz, F., & Barakat, L. P. (2018). Screening for family psychosocial risk in pediatric cancer: Validation of the psychosocial assessment tool (PAT) Version 3. Journal of Pediatric Psychology. https://doi.org/10.1093/jpepsy/jsy012.Google Scholar
- Kittredge, D., Baldwin, C. D., Bar-on, M. E., Beach, P. S., & Trimm, R. F. (2005) APA educational guidelines for pediatric residency: Pediatric competencies in brief: Developmental and behavioral pediatrics. Retrieved from. Accessed March 28, 2018, from http://www.ambpeds.org/egweb.
- McMillan, M. A., Land, M. L., Rodday, A. M., Wills, K., Green, C. M., & Leslie, L. K. (2018). Report of a joint association of pediatric program directors–American board of pediatrics workshop: Preparing future pediatricians for the mental health crisis. The Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2018.06.044.Google Scholar
- Meyer, R. J., & Haggerty, R. J. (1962). Streptococcal infections in families. Factors altering individual susceptibility. Pediatrics, 29, 539–549.Google Scholar
- Vanderbilt, D., Bushley, T., Young, R., & Frank, D. A. (2009). Acute posttraumatic stress symptoms among urban mothers with newborns in the neonatal intensive care unit: a preliminary study. Journal of Developmental and Behavioral Pediatrics. https://doi.org/10.1097/DBP.0b013e318196b0de.Google Scholar