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A psychological behavioral screening service: use, feasibility, and impact in a primary care setting. (41/1477)

OBJECTIVE: To describe a psychology behavioral screening service and the use of the service in subsequent primary care provider (PCP) treatment decisions. METHODS: The goal of the behavioral screening service was to obtain standardized parent and teacher rating scale data for children identified by PCPs as having possible behavioral problems. Medical chart review data were collected on 147 children for 1 year following screening to evaluate (1) PCP follow-up of the behavioral concern, (2) prescription of psychotropic medications, (3) referral to mental health services, and (4) receipt of mental health services. RESULTS: Children screened by this psychology service had clinically significant behavioral problems, according to both parent and teacher data; PCPs appeared to use screening results to guide decisions about medication prescription but not mental health referrals. Children with more behavioral problems were more likely to be prescribed psychotropic medications and to be seen by a mental health professional. CONCLUSIONS: These data suggest that a psychology behavioral screening service is feasible and may help guide PCP treatment decisions for children with behavior problems, particularly regarding the prescription of psychotropic medication.  (+info)

Predictors of unintentional injuries to school-age children seen in pediatric primary care. (42/1477)

OBJECTIVE: To identify predictors of unintentional injury to school-age children seen in pediatric primary care. METHODS: Members of a managed health care system (295 children ages 5-11 years and their mothers) participated. We used Time 1 measures of child, maternal, and family functioning and health care utilization to predict rates of unintentional child injury for the following year. Multiple regression analyses were performed to identify variables contributing to prospective injury rates. RESULTS: The final regression model included eight Time 1 variables and accounted for 21% of the variance in Time 2 injury rates. Significant predictors of increased injury liability were younger child age, more children at home, child behavior problems, child social competence, three indices of reduced child health, and maternal anxiety. CONCLUSIONS: We discuss the utility of these predictors for pediatric psychologists in targeting primary care preventive interventions to families at risk for unintentional child injury.  (+info)

Brief report: parent report about health care use: relationship to child's and parent's psychosocial problems. (43/1477)

OBJECTIVE: To investigate the potential utility of asking parents about health care utilization as a means of identifying individuals at risk for psychosocial problems. METHOD: Parents of 366 children ages 2 to 16 completed questionnaires about their own, their child's, and their family's psychosocial functioning and health care utilization. RESULTS: Children and parents with high health care utilization were more likely to have psychosocial problems than those with low health care utilization. Sensitivity and specificity of health care utilization as a marker for psychosocial problems ranged from 43.8% to 68.8%. CONCLUSIONS: Although high rates of child health care utilization are related to the presence of psychosocial problems, use of this measure alone could result in many false-positive and false-negative identifications. Rather, use of health care utilization data in conjunction with other screening measures may be useful for alerting physicians to the possibility of both child and parent psychosocial problems.  (+info)

Brief report: learning to parent: a survey of parents in an urban pediatric primary care clinic. (44/1477)

OBJECTIVE: To survey parents bringing children to an urban pediatric primary care clinic about (1) how they learned parenting skills, (2) role of the clinic in teaching parenting, (3) helpfulness of information sources, and (4) preferred modalities for teaching. METHODS: A total of 108 adults completed an oral survey in clinic, consisting of open-ended questions, yes/no endorsements, Likert ratings, and demographic questions. RESULTS: The majority reported learning to parent from their families or "by just doing it." Talking with professionals was rated as very helpful. Most had parenting questions. Almost half wanted information regarding specific developmental/behavioral issues, while only 8% wanted medical information. Most felt they could talk with clinic professionals about concerns but fewer had done so. Modality preferences were reported. CONCLUSIONS: Inner-city parents value working with primary care providers to improve knowledge of developmental/behavioral issues. Results have implications for the anticipatory guidance process, content of information provided, and the training of pediatric healthcare providers. We determined preferences for information delivery.  (+info)

Commentary: collaboration in pediatric primary care: a pediatrician's view. (45/1477)

Although neither pediatricians nor psychologists can provide alone for the vast needs of children and families in our increasingly complex society, these needs can be met through effective collaboration. An ideal model for collaboration would exist if pediatricians and psychologists worked together in practice teams, for which developmental-behavioral pediatricians might serve as consultants. Together, these professionals could take responsibility for professional education, expanded clinical care, liaisons with schools and other community-based resources for children and families, and research that addressed questions about the development, coping, and correction of children's and families' difficulties.  (+info)

Children in an ageing society.(46/1477)

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Adoption: a forgotten paediatric speciality. (47/1477)

OBJECTIVE: To study the medical, emotional, and developmental profile of children being considered for permanent substitute care. DESIGN: A retrospective analysis of 100 adoption/permanency medicals. SETTING: All children considered by the adoption and permanency panel in Greenwich, south east London, between 1994 and 1998. OUTCOME MEASURES: Analysis of medical reports completed using the British Agencies for Adoption and Fostering form C (under 5 years) or form D (over 5 years). These include the details of a physical examination, including vision, hearing, height, and weight; emotional and behavioural concerns expressed by the foster carer and school progress. RESULTS: These children have complex needs. Only 31 of the 100 children were considered unlikely to have significant medical, developmental, or emotional problems. CONCLUSIONS: Adoption medical work is becoming more specialised. Healthcare commissioners should establish minimum standards for the doctors involved in this work. As the NHS moves towards becoming a more primary care led organisation, this small service must not be forgotten. The NHS devotes few resources and little training to adoption. The medical input required to support adoption and fostering services should be recognised as a specialist paediatric service and adequately resourced.  (+info)

Exploring the scope for advocacy by paediatricians. (48/1477)

AIMS: To ascertain the type and extent of problems requiring advocacy in paediatrics. To develop an approach for analysing problems according to their root causes and the level of society at which advocacy is needed. METHODS: Nine paediatricians kept detailed clinical diaries for two weeks to identify problems. Classifications were developed to categorise problems by cause and the level of society at which they needed to be addressed. The press was surveyed for one week for childhood issues attracting media attention. RESULTS: 60 problems requiring advocacy were identified. Root causes included failures within agencies, between agencies, and inadequate provision. In addition to advocacy required individually, "political" action was needed at the community level (16 issues), city level (16 issues), and nationally (15 issues). 103 articles were found in the press, these did not relate closely to issues identified by clinicians. CONCLUSIONS: Many opportunities for advocacy arise in the course of daily work. A systematic way of analysing them has been developed for use in planning action. To optimise the health and health care of children, there is a need to train and support paediatricians in advocacy work for local as well as national issues. Ten issues were identified that might be prioritised by paediatricians working on an agenda for action.  (+info)