Does one-day educational training improve the quality of mental healthcare pediatricians' provide to children in their practices? The Reaching Children Initiative (RCI)

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 physicians (PCP'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, immediately after, 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, 64% of the primary care clinicians reported instituting practice changes recommended during training. Reported use of formal mental health screening instruments increased from baseline to 6-months for attention problems (50% to 64%) and for depression (17% to 33%). Greater use of medications for treating mental health problems was more limited. PCP's reported that parents responded positively to the PCP's increased interest in their children's mental health. However, although participants initially indicated strong agreement with the desirability to implement mental health specific practice changes, perceived desirability of such changes declined substantially after 6-months. Conclusion: Changes in PCP's mental health related practice procedures can be facilitated by educational interventions, but continued training in diagnosing and treating children's mental health problems may be needed.