Changing Practice Procedures to Better Diagnose and Treat Mental Health Problems in Children and Adolescents: The Reaching Children Initiative

Objective: The 1999 Surgeon General report on mental health found that diagnosable mental health problems are seen in nearly 21% of children and adolescents age 9-17. Primary care clinicians (PCC's) can address these mental health issues, but report much uncertainty in their skills to identify and treat such children. Methods: Between November 2005, and June 2006 137 pediatricians attended an all-day training session on children's mental health. We surveyed attendees prior to their session and immediately after it, and 1- and 6-months later. Measures: Outcomes of interest were implementing practice changes, use of formal screeners for mental health problems, and use of mental health medications. Results: At 6-months, about 64% of the attendees said that their practice had instituted changes discussed during the training sessions. Practice changes at 6-months were associated with greater use of medications for treating mental health problems. Participants who reported practice changes also indicated that more than 80% of parents appreciated interest in the mental health of their child and 76% said that families liked being included in setting goals for the child's psychosocial issues. At baseline, less than half of the participants said that their practice routinely used a formal screening instrument for attention problems, while less than 20% formally screened for depression. These percentages increased to 64% and 33% for attention problems and depression at 6-months. Conclusion: Changes in PCC's practice procedures may be facilitated by educational interventions, but PCC's could benefit from further training in diagnosing and treating children's mental health problems.