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Do Pediatricians Think They Are Responsible for Identification and Management of Child Mental Health Problems? Results of the AAP Periodic Survey

  • Ruth E.K. Stein
    Correspondence
    Address correspondence to Ruth E. K. Stein, MD, Department of Pediatrics, AECOM/Montefiore, 111 East 210 Street, Bronx, New York 10467.
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein); Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Horwitz); Center for Clinical Investigation (Ms Storfer-Isser), Department of Pediatrics (Dr Heneghan), Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Research, American Academy of Pediatrics, Elk Grove, Ill (Dr Olson); and Department of Psychiatry, Columbia University, New York, NY (Dr Hoagwood)
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  • Sarah McCue Horwitz
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein); Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Horwitz); Center for Clinical Investigation (Ms Storfer-Isser), Department of Pediatrics (Dr Heneghan), Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Research, American Academy of Pediatrics, Elk Grove, Ill (Dr Olson); and Department of Psychiatry, Columbia University, New York, NY (Dr Hoagwood)
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  • Amy Storfer-Isser
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein); Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Horwitz); Center for Clinical Investigation (Ms Storfer-Isser), Department of Pediatrics (Dr Heneghan), Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Research, American Academy of Pediatrics, Elk Grove, Ill (Dr Olson); and Department of Psychiatry, Columbia University, New York, NY (Dr Hoagwood)
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  • Amy Heneghan
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein); Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Horwitz); Center for Clinical Investigation (Ms Storfer-Isser), Department of Pediatrics (Dr Heneghan), Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Research, American Academy of Pediatrics, Elk Grove, Ill (Dr Olson); and Department of Psychiatry, Columbia University, New York, NY (Dr Hoagwood)
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  • Lynn Olson
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein); Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Horwitz); Center for Clinical Investigation (Ms Storfer-Isser), Department of Pediatrics (Dr Heneghan), Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Research, American Academy of Pediatrics, Elk Grove, Ill (Dr Olson); and Department of Psychiatry, Columbia University, New York, NY (Dr Hoagwood)
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  • Kimberly Eaton Hoagwood
    Affiliations
    From the Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY (Dr Stein); Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Horwitz); Center for Clinical Investigation (Ms Storfer-Isser), Department of Pediatrics (Dr Heneghan), Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Research, American Academy of Pediatrics, Elk Grove, Ill (Dr Olson); and Department of Psychiatry, Columbia University, New York, NY (Dr Hoagwood)
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      Objective

      Childhood psychosocial problems have profound effects on development, functioning, and long-term mental health. The pediatrician is often the only health professional who regularly comes in contact with young children, and it is recommended that health care supervision should include care of behavioral and emotional issues. However, it is unknown whether pediatricians believe they should be responsible for this aspect of care. Our objective was to report the proportion of physicians who agree that pediatricians should be responsible for identifying, treating/managing, and referring a range of behavioral issues in their practices, and to examine the personal physician and practice characteristics associated with agreeing that pediatricians should be responsible for treating/managing 7 behavioral issues.

      Methods

      The 59th Periodic Survey of members of the American Academy of Pediatrics was sent to a random sample of 1600 members. The data that are presented are based on the responses of 659 members in current practice and no longer in training who completed the attitude questions.

      Results

      More than 80% of respondents agreed that pediatricians should be responsible for identification, especially for attention-deficit/hyperactivity disorder (ADHD), eating disorders, child depression, child substance abuse, and behavior problems. In contrast, only 59% agreed that pediatricians were responsible for identifying learning problems. Seventy percent thought that pediatricians should treat/manage ADHD; but for other conditions, most thought that their responsibility should be to refer. Few factors were consistently associated with higher odds of agreement that pediatricians should be responsible for treating/managing these problems, except for not spending their professional time exclusively in general pediatrics.

      Conclusions

      These data suggest that pediatricians think that they should identify patients for mental health issues, but less than one-third agreed that it is their responsibility to treat/manage such problems, except for children with ADHD. Those not working exclusively in general pediatrics were more likely to agree that pediatricians should be responsible for treating and managing children's mental health problems.

      Key Words

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