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.

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.

Recent literature, public policy, and funding opportunities call attention to the need for better increased integration of health and mental health care services in primary care settings so as to best meet the needs of children and families. There are many benefits to such integration, but pediatric primary care providers (PCPs) face multiple barriers to identifying and managing patients with mental health difficulties. One way to address this problem is through the integration of psychologists into primary care settings who can collaborate with PCPs to provide integrated behavioral health care to youth and families. However, there are challenges to collaboration, which include differences in training, professional cultures, and expectations held by professionals from various disciplines. Effective communication is a key component in supporting interprofessional collaboration between primary care providers and psychologists working in primary care settings. This paper reviews aspects of pediatric medicine culture, critical components of communication, and strategies to improve communication. Three case examples are presented in which some of these challenges have been successfully addressed. Implications and future directions are discussed.

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.

As many as 20% of children are need in of mental health services but only a small percentage receive them. Primary care pediatricians are often the first providers to see these children so it is critical to understand how they manage their care. Therefore, we developed a vignette-based survey to obtain data about pediatricians’ mental health-related diagnostic accuracy, confidence and comfort level in diagnosis and management, and decisions related to care. Pediatricians (N = 106) responded to one of two vignettes, one describing a child with symptoms consistent with ADHD, inattentive type, and the other with symptoms of a depressive disorder. Overall diagnostic accuracy was ~60%, although pediatricians who received the ADHD vignette indicated greater confidence in their diagnosis and greater likelihood of providing treatment themselves. Those who received the ADHD vignette were also more likely to conduct a next level assessment and not to refer to a specialist. Participant characteristics, other than level of interest in mental health, were generally not associated with accuracy, confidence, comfort level, and decisions. Neither years in practice nor completion of a residency rotation in developmental and behavioral pediatrics yielded significant differences in or correlations with diagnosis and management. Consistent with previous reports, pediatric primary care providers vary in their responses to mental health concerns, depending upon the symptom presentation. Primary care providers in our study also appear to value consultation with mental health specialists, supporting the importance of interprofessional collaboration in caring for children with mental health related concerns.

Current theories regarding grief and mourning often acknowledge continued connection and reworking of the relationship to the lost person rather than relinquishing ties and bonds, and acknowledge the importance of culture in grief and mourning. Although there is little research regarding Italian-Americans and grieving, these ideas fit well with the description described by researchers as ‘Italians tend to keep their dead with them’. This paper explores Italian-American responses to the loss of a loved one. It comprises a brief summary of relevant literature around grieving, followed by an overview of themes from Italian traditions and culture that inform our thinking about Italian-Americans and grief. The authors, as participants in both the culture and the experience of grief, briefly situate themselves vis-à-vis these experiences. Three segments then illustrate our concepts of continued bonds and reworking relationships: a pilot study of Italian-Americans’ experiences of loss and grieving over time, a normative case study of one woman’s creative, ongoing response to major loss, and the importance of objects after loss from a research project of daughters who have lost their dads. Conclusions focus on the importance and complexity of mourning; the centrality of relationship; the use of symbol, ritual and meaning-making; and development of resiliency, for Italian-Americans and perhaps other groups.

Although there is an abundance of literature focusing on social support for children and adults with mental illness, there is a paucity of research examining social support for individuals diagnosed with childhood and adolescent onset schizophrenia. Literature suggests that measuring social support in youth with schizophrenia poses unique challenges, which may be why it is so under-represented in existing research. In an effort to learn more about the availability of social support for children in this population, the current study compared measures of social support for children and adolescents, 5 to 17 years old, diagnosed with childhood schizophrenia to those for children diagnosed with autism spectrum disorder. The study surveyed parents of children with schizophrenia and autism using the Family Needs Questionnaire to measure perceived social support, and a subsection of the Ohio Youth Problem, Functioning, and Satisfaction Scales to measure the parent's assessment of children's level of functioning. A Family Questionnaire was also administered to collect demographic information about the children and their families. Results indicated, contrary to the original hypothesis, that parents of children with schizophrenia perceived their offspring as having more social support than children with autism, even though overall parents of children in the schizophrenia group rated their children as having a lower level of functioning. However, the study also found that when assessing the importance of social support needs, parents of children with schizophrenia rated their children's needs as being significantly more important than parents of children with autism. A discussion of the research findings and limitations of the study are offered, in addition to suggestions for future research.

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

Pediatric primary care providers (PCPs) play a critical role in caring for children with mental health concerns. Some states have introduced programs to support PCPs in managing these patients more independently. The Massachusetts Child Psychiatry Access Project consultation program is one example. This study compared responses from PCPs in Massachusetts (n = 73) with PCPs in Indiana (n = 33), a state without a consultation program, to vignettes about children with possible attention-deficit/hyperactivity disorder or depression. Participants from MA indicated a stronger interest in behavioral health issues and were more likely to screen patients. PCPs from IN were more likely to have completed a rotation in developmental and behavioral pediatrics during residency. IN respondents were also more likely to choose the correct diagnosis for vignettes and less likely to refer to a psychiatric provider for psychotropic medication. Results suggest greater independence for PCPs in IN.

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.

The Incredible Years (IY) parent, teacher, and child training series, developed by Carolyn Webster-Stratton, has been studied extensively over the past several decades by the developer, her associates, and by other researchers. While Webster-Stratton has recently summarized much of her work, this paper provides a brief description of the IY programs and focuses on studies published by independent researchers. We review peer-reviewed papers that included either a control group or another intervention group in their design, with particular attention to each training program, combinations of training programs, multicultural applications, and interventions with special populations (e.g., foster parents, children with neurodevelopmental disorders). We also consider the literature on cost-benefit analyses of the program. There is solid evidence for the training program for parents of young children, and the literature provides support for its international applicability, but there is a paucity of independent research addressing the parent programs for children of other ages, the teacher program, the Dina Dinosaur program for young children, and combined programs. We conclude the review with directions for future research and a discussion of the limitations of our own review.

Although the increasing focus on female leadership in both the popular press and scholarly literature is relatively recent, women's leadership is not. Women have traditionally played a role in civic and cultural arenas and now have a greater opportunity to bring their particular leadership strengths to a broad range of organizations. The current paper reports on a case study about participants’ attitudes after participating in a leadership seminar series program for female graduate students at a university in the Northeast. The program's design incorporated networking, goal setting, skills training, and mentoring. Postprogram results (N = 17) on measures of Houghton and Neck's Revised Self‐Leadership Questionnaire indicated significant changes on all three of the leadership questionnaire's dimensions as well as on several subscales within the dimensions indicating that after the leadership training, the women were adapting to more transactional practices such as self‐reward and goal setting.

As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental health providers would differ in their care of patients with mental health concerns when compared to PPCPs not in such relationships.

We examined the content of commercials airing on 9 general TV channels (ABC, CBS, NBC, PBS, Fox, WB, CNN, MTV, and ESPN) and investigated whether channel, time of day, and program rating were predictors of the rates of positive and negative content. The rate of negative content for the 9,571 commercials airing on the general channels (13.7%) was significantly less than the rate of positive content (20.2%) and not unlike the rate of negative content for the 2,433 commercials airing on 3 children's channels (Cartoon Network, Disney Channel, Nickelodeon; 14.8%). Commercials airing on the general channels included significantly more positive content than commercials airing on the children's channels (15.7%). Commercials airing on ABC and NBC and during TV-Y programs were more likely to include positive content and less likely to include negative content, whereas commercials airing on MTV and during TV-14 programs were more likely to include negative content. Overall, time of day was not a significant predictor of the content of the commercials, and only the L label was suggestive of negative content in commercials. Clinicians should educate parents about the negative content in commercials and advocate for greater parity between the televised programs and the corresponding commercials.

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.

Two hundred and twenty-seven graduates of doctoral programs in psychology and current psychology doctoral students who were subscribers to the Society of Clinical Child and Adolescent Psychology's (Division 53 of the American Psychological Association; APA) electronic mailing list completed an online survey about their training experiences. Results indicated that training in clinical child psychology encompasses both breadth and depth in areas including various types of assessment and intervention strategies, research methods, and evidence-based practice. Survey responses also suggest that there have been changes over time with respect both to endorsed theoretical orientations and to some curriculum-related topics. Participants reported the availability and completion of a broad range of practicum experiences, with an emphasis on those related to children. We discuss the core findings, differences over time, and comparisons with the last similar survey published nearly three decades ago.

As many as 15 million children and adolescents in the United States are in need of behavioral health services, and it is often the pediatric primary care system that is their first contact with formal assessment and intervention services. However, pediatric primary care providers (PPCPs) face challenges to assessing and managing children with behavioral health concerns, including lack of time, lack of training, and lack of behavioral health specialists to whom they can refer. The Connecticut Behavioral Health Partnership has forged relationships between primary care and behavioral health providers through its enhanced care clinic (ECC) initiative, which focuses on improved access to behavioral health services and coordination of care for children insured by Medicaid. We report on interviews with 24 PPCPs and 8 staff/administrators from 12 pediatric practices throughout the state about their experiences with the ECCs. The majority of participants expressed satisfaction with the behavioral health partnerships and, based on their experience, would join the partnership again.