Identification of youth psychosocial problems during pediatric primary care visits
Identification of youth psychosocial problems during pediatric primary care visits
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DOI：
10.1007/s10488-006-0106-7
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发表时间：
2007-05-01
影响因子：
2.6
通讯作者：
Wissow, Lawrence S.
中科院分区：
文献类型：
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作者：
Brown, Jonathan D.;Riley, Anne W.;Wissow, Lawrence S.
本研究运用儿童心理健康服务的门户提供者模式(GPM)，探讨儿童、家庭、就诊及提供者的特征是否与初级保健期间青少年心理社会问题的识别有关。数据是在对13家诊所的54家初级保健提供者(PCP)进行774次访问期间收集的。与以前在初级保健环境中的调查类似，42%的青年至少表现出临床界外心理健康问题。大多数PCP报告说工作满意度和控制力很高，但报告说找心理健康专家的机会不同。初级保健医生通常对治疗心理社会问题有积极的态度和信念，但许多人报告说，这样做是沉重的负担。当走访是因为精神健康问题、当走访期间讨论了与心理社会问题有关的问题、当青年表现出精神健康症状、损害或家庭负担时，以及当青年年龄较大、没有保险或接受医疗补助时，更有可能进行身份识别。当初级保健医生报告与治疗心理社会问题相关的更大负担时，以及当初级保健医生报告更容易接触到精神健康专家时，识别的可能性较小。这些结果表明，识别与多水平因素的交互作用有关，GPM是一个有用的模型，可以用来调查干预点，以提高初级保健环境中儿童心理健康问题的识别能力。
This investigation applied the Gateway Provider Model (GPM) of child mental health services to investigate whether characteristics of the child, family, visit, and provider were related to the identification of youth psychosocial problems during primary care visits. Data were gathered during 774 visits to 54 primary care providers (PCPs) at 13 clinics. Similar to previous investigations in primary care settings, 42% of youth demonstrated at least a sub-threshold clinical mental health problem. Most PCPs reported high job satisfaction and control, but reported varying access to mental health specialists. PCPs generally had positive attitudes and beliefs about treating psychosocial problems but many reported that doing so was burdensome. Identification was more likely when the visit was for a mental health problem, when issues related to psychosocial problems were discussed during the visit, when the youth demonstrated mental health symptoms, impairment, or burden to the family, and when the youth was older, uninsured, or received Medicaid. Identification was less likely when the PCP reported greater burden associated with treating psychosocial problems and when the PCP reported greater accessibility to mental health specialists. These results suggest that identification is associated with the interaction of multilevel factors and that the GPM is a useful model to investigate points of intervention for improving the identification of children's mental health problems in primary care settings.