Social Network Analysis as a Tool to Inform a Children's Hospital's Efforts to Improve Population Health.

OBJECTIVES: A children's hospital explored the feasibility and utility of social network analysis as a tool for system building in community child health, to identify gaps and opportunities in community partnerships, and to assess its role as a contributor to collective impact. METHODS: We employed social network analysis with the PARTNER survey to assess relationships among community-based organizations and a children's hospital's community-oriented programs. We utilized a two-stage, snowball sampling strategy to identify community partners. We analyzed social capital, network density, degree centralization, perceived trust, and perceived value. Network mapping depicted the hospital programs' relationships with community partners. RESULTS: Of the 153 contacted potential respondents, 76 responded for a response rate of 50%. Respondents reported a total of 1116 ties, ranging in strength from awareness and cooperation to coordination and integration. Approximately 60% of network members could reach 100 or more members in 2 steps or less. The overall network trust score was 74%. Network mapping indicated that hospital programs enhance bonding relationships within sectors, bridge gaps between partners from different sectors, and provide linkages to resources such as funders. Deficits in bonding, bridging, and access to funding are evident when the hospital's programs are omitted from network maps. CONCLUSIONS: Findings support the feasibility and utility of social network analysis as a tool for system building in community child health. The study demonstrates the potential of a children's hospital's programs to provide social capital in the form of bonding, bridging, and linking relationships.

Family History of Mental Health Disorders and Parental Help-Seeking for Behavioral Health Concerns in Pediatric Primary Care Offices.

INTRODUCTION: Pediatric mental health needs are common in primary care, but many children never access treatment. With parents as a critical gatekeeper, it is important to identify barriers and facilitators to treatment access and explore the role of family history. METHOD: Parents/caregivers (N = 1,763) with children aged 3-17 years were recruited in the original study and participated in a 71-item survey that addressed mental health-related communication. RESULTS: An association was found between family history of mental health disorders and recognition of behavioral concerns, and between anxiety/depression disorders and sharing of concerns. In addition, parents with a family history were less likely to feel completely satisfied with time spent discussing mental health or with how the provider answered questions. DISCUSSION: Although fear of stigma has been previously cited in the literature as a barrier to accessing treatment, findings suggest a family history of mental health disorders can facilitate parental help-seeking steps.

Parent Perceptions of Pediatric Primary Care Providers' Mental Health-Related Communication and Practices.

INTRODUCTION: The pediatric primary care office is an ideal setting to address children's socioemotional-behavioral health. However, research is limited regarding parents' experiences and satisfaction in sharing mental-health concerns about their children during well-child visits. METHOD: One thousand seven hundred sixty-three parents and caregivers with children aged 3-17 years completed an online survey that addressed mental-health-related communication. RESULTS: Findings supported the key role that primary care providers play in communicating about mental-health issues; 75% of parents who had such a concern about their child raised it during the visit, although the majority desired more time devoted to discussing mental health. Parents' comfort discussing mental-health concerns was inversely related to providers' dismissing those concerns. DISCUSSION: Despite satisfaction with how providers addressed mental-health issues, results suggested that nonjudgmental, knowledgeable staff and discussion of child and parent strengths could facilitate both parental comfort and communication between parents and pediatricians.

The Relationship Between Body Mass Index in Children and Insurance Type, Parental Eating Concern, Asthma, and Allergies.

INTRODUCTION: Trust for America's Health reported rising levels of obesity contributed to increased disease rates and health care costs (Levi et al., 2013). Factors associated with overweight and obesity rates include lower socioeconomic status, public insurance, and increased chronic disease rates. METHODS: Body mass index percentile, health insurance, parental eating concern, asthma, and allergy information were evaluated from a dataset of 870 de-identified health assessment records. RESULTS: Among overweight/obese children, we found significant differences in children insured by Medicaid (26%) versus commercial insurance (15.9%), children with asthma (22.1%) versus children without asthma (14.8%), and children with known allergies (7.8%) versus children without known allergies (16.7%). The difference between children with parental eating concerns (3.7%) and children without (18.1%) was nearly significant. DISCUSSION: The associations depicted can assist pediatric providers in recognizing risk factors for overweight/obesity among their patients. Combating obesity in childhood can improve health outcomes.

Pediatric primary care providers' reported likelihood to refer to mental health specialists.

INTRODUCTION: Pediatric primary care providers (PPCPs) play an increasingly important role in addressing mental health concerns. Yet PPCPs are limited in the services they can provide because of constraints in training, time, and reimbursement. Whereas some patients may be appropriately treated in primary care, others require referrals to mental health specialists. The current study evaluated patient, clinician, and situational factors associated with PPCPS' reported likelihood to refer hypothetical patients with mental health concerns to mental health specialists. METHOD: The sample included 106 PPCPs from Massachusetts and Indiana who read one of two vignettes of hypothetical patients (one with symptoms of attention-deficit hyperactivity disorder (ADHD) and one with symptoms of depression) and then completed surveys regarding patient diagnosis and treatment decisions. RESULTS: Results indicated that PPCPs who read the depression vignette were significantly more likely to report intentions to refer the patient to a mental health specialist than those who read the ADHD vignette as were PPCPs with less confidence in treating mental health concerns. PPCPs who read the depression vignette were also more likely to report intentions to refer to psychologists and social workers as opposed to PPCPs who read the ADHD vignette, who reported intentions to refer to psychiatrists. Training in developmental and behavioral pediatrics was not related to reported likelihood of referring. CONCLUSION: These findings illuminate potential areas for future research on referral patterns from primary care to mental health specialists. (PsycINFO Database Record

A Clinical Care Algorithmic Toolkit for Promoting Screening and Next-Level Assessment of Pediatric Depression and Anxiety in Primary Care.

With a documented shortage in youth mental health services, pediatric primary care (PPC) providers face increased pressure to enhance their capacity to identify and manage common mental health problems among youth, such as anxiety and depression. Because 90% of U.S. youth regularly see a PPC provider, the primary care setting is well positioned to serve as a key access point for early identification, service provision, and connection to mental health services. In the context of task shifting, we evaluated a quality improvement project designed to assist PPC providers in overcoming barriers to practice-wide mental health screening through implementing paper and computer-assisted clinical care algorithms. PPC providers were fairly successful at changing practice to better address mental health concerns when equipped with screening tools that included family mental health histories, next-level actions, and referral options. Task shifting is a promising strategy to enhance mental health services, particularly when guided by computer-assisted algorithms.

"Doctor, are you listening?" Communication about children's mental health and psychosocial concerns.

Effective communication is critical, including in the pediatric primary care setting. Pediatric primary care providers (PPCPs) are in a unique position to address psychosocial and mental health concerns during office visits, and effective communication skills play a crucial role in providing an opportunity for parents and patients to disclose and discuss such concerns. In this article, the authors encourage two relatively simple strategies that have shown potential for enhancing effective communication in pediatric primary care regarding mental health and psychosocial issues: (a) ensure that pediatric residents and practicing providers have access to brief, targeted communications training and (b) strongly promote the use of screening tools both to encourage discussion and to assist in identifying children who may benefit from further assessment and/or treatment. (PsycINFO Database Record

Strengthening the Coordination of Pediatric Mental Health and Medical Care: Piloting a Collaborative Model for Freestanding Practices.

BACKGROUND: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model. OBJECTIVE: The current study evaluates the field test of the Practitioner-Informed Model to Facilitate Interdisciplinary Collaboration (PIM-FIC), a systematic approach to improving inter-professional collaboration by building relationships and enhancing communication between pediatric mental health and primary care practices. METHODS: Thirty-nine providers at two mental health and two pediatric primary care practices participated in a pilot project and completed surveys prior to and following their participation. Key informant interviews were also conducted prior to the project. RESULTS: Participating practitioners' survey and interview responses indicate that the quantity and quality of communication between pediatric mental and medical health care providers increased post-project, as did satisfaction with overall collaboration. CONCLUSIONS: Improving relationships and communication are first steps in building the infrastructure to support effective coordinated care. Project results highlight practical and easily implemented strategies that pediatric mental health and primary care practices can take to strengthen their collaboration. Findings also suggest a need for collaborative care policies and competencies for child mental health providers working in freestanding practices within the PCMH-N.

Pediatric psychopharmacology: context, model programs, and considerations for care.

Research indicates that one in five children and adolescents in the United States has a behavioral or emotional disorder and a substantial number use psychotropic medications. Pediatric primary care providers play an important role in prescribing and managing psychotropic medications. However, they face several challenges with respect to prescribing these medications, including training, confidence, and level of comfort. One way to meet these challenges is through comanagement of behavioral health care, including psychopharmacology, by pediatric primary care providers and child mental health care providers. The authors review literature on patterns of psychotropic medication prescribing for children and adolescents and the role of pediatric primary care providers. They describe two statewide models that were developed to improve pediatric primary care providers' ability to treat patients with behavioral health needs, including prescribing psychotropic medications, by linking them to support from child mental health providers. The authors conclude with recommendations to improve professional training and collaboration.

Engaging pediatricians in developmental screening: the effectiveness of academic detailing.

Use of formal developmental screening tools in the pediatric medical home improves early identification of children with developmental delays and disorders, including Autism Spectrum Disorders. A pilot study evaluated the impact of an academic detailing module in which trainers visited 43 pediatric primary care practices to provide education about implementing developmental screening tools in well-child services. Attendees responded to a post presentation survey stating that they planned to implement screening in their practices. Medicaid billing data showed an increase in the state's overall rate of screening. An audit of medical charts in five practices that received the training and five that did not showed higher screening rates in practices that received the training as well as higher rates after the training than before. These pilot study results indicate the potential of academic detailing as an effective strategy for improving rates of developmental screening.