Online Program

Pediatrician practices regarding mental health care in a community health center setting

Monday, November 4, 2013

Katherine Hobbs Knutson, MD, Harvard School of Public Health, Harvard University, Boston, MA
Nisha Thakrar, MD, South Boston Community Health Center, Boston, MA
Objective: Many children are treated for mental health problems in primary care settings. In this study, we describe mental health conditions evaluated and psychotropic medications prescribed most frequently by pediatricians at an urban community health center. We also describe pediatricians' relative comfort managing specific mental health conditions and psychotropic medications within primary care. Methods: At the South Boston Community Health Center in Boston, Massachusetts five pediatricians provide primary care services for approximately 3,800 individuals <25 years old. Pediatricians completed a survey ranking mental health conditions evaluated and psychotropic medications prescribed most frequently in their primary care practices. Pediatricians also reported their comfort managing specific mental health diagnoses and psychotropic medications using a 5-point Likert scale with higher scores indicating greater comfort. Results: Pediatricians reported frequently evaluating children with depressive disorders and disruptive behavioral disorders including ADHD, and prescribing antidepressant and ADHD medications. Pediatricians reported relative comfort managing children with ADHD (mean=3, CI=2.3-3.7) and developmental disorders (mean=3.4, CI=2.5-4.3) and prescribing ADHD medications (mean=3.9, CI=2.8-5.0). Pediatricians were relatively uncomfortable managing depressive disorders (mean=2, CI=0.8-3.2), bipolar disorder (mean=1.6, CI=0.7-2.5) or psychosis (mean=1.4, CI=0.9-1.9), and they were less willing to prescribe antipsychotic (mean=1.8, CI=0.5-3.1) or mood stabilizer (mean=1.8, CI=0.5-3.1) medications. Conclusions: At this urban community health center, pediatricians frequently evaluate and treat children with mental health disorders, but they report relative discomfort managing conditions other than ADHD and developmental disorders within primary care. Interestingly, pediatricians frequently evaluate and treat children with depressive disorders, but reported relative discomfort in this practice.

Learning Areas:

Provision of health care to the public
Public health or related research

Learning Objectives:
Describe pediatrician practices and perceived ability to provide mental health services in a primary care community health center setting.

Keyword(s): Child/Adolescent Mental Health, Community Health Centers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator for the quality improvement project for integrating mental health and pediatrics services at the South Boston Community Health Center. Among my scientific interests is mental health services research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.