When Behavioral Health Concerns Present in Pediatric Primary Care: Factors Influencing Provider Decision-Making

  • Elizabeth H ConnorsEmail author
  • Prerna Arora
  • Angela M. Blizzard
  • Kelly Bower
  • Kelly Coble
  • Joyce Harrison
  • David Pruitt
  • Janna Steinberg
  • Lawrence Wissow


Primary care providers (PCPs) frequently encounter behavioral health (BH) needs among their pediatric patients. However, PCPs report variable training in and comfort with BH, and questions remain about how and when PCPs address pediatric BH needs. Existing literature on PCP decisions to address pediatric BH in-office versus referring to subspecialty BH is limited and findings are mixed. Accordingly, this study sought to examine parameters and contextual factors influencing PCP decisions and practices related to BH care. Qualitative interview results with 21 PCPs in Maryland indicated that decisions about how and when to address pediatric BH concerns are influenced by the type BH service needed, patient characteristics, the availability of BH services in the community, and possibly PCPs’ perceptions of BH care as a distinct subspecialty. Findings suggest that efforts to support individual PCPs’ capacity to address BH within primary care must be balanced by efforts to expand the subspecialty BH workforce.



The authors would like to thank the 21 pediatric primary care providers who participated in this study, as well as Ms. Jennifer Stevenson and Ms. Kristen Wigand for their generous support in preparing this paper for submission. This project was supported by the Maryland Department of Health under grant number 17-17180G.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© National Council for Behavioral Health 2017

Authors and Affiliations

  • Elizabeth H Connors
    • 1
    Email author
  • Prerna Arora
    • 2
  • Angela M. Blizzard
    • 3
  • Kelly Bower
    • 4
  • Kelly Coble
    • 1
  • Joyce Harrison
    • 4
  • David Pruitt
    • 1
  • Janna Steinberg
    • 4
  • Lawrence Wissow
    • 4
  1. 1.University of Maryland School of MedicineBaltimoreUSA
  2. 2.Pace UniversityNew YorkUSA
  3. 3.Florida International UniversityMiamiUSA
  4. 4.Johns Hopkins UniversityBaltimoreUSA

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