Are pediatricians doing more family "therapy" than they realize? Changing families through single encounters.
Are pediatricians doing more family "therapy" than they realize? Changing families through single encounters.
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儿科医生所做的家庭“治疗”是否比他们意识到的要多？
DOI：
10.1177/0009922812453198
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发表时间：
2013
影响因子：
1.6
通讯作者：
Lynch,Sean
中科院分区：
文献类型：
--
作者：
Larson,Justine;Mitchell,LauraE;Lynch,Sean
在过去的十年中，美国儿科学会和美国儿童和青少年精神病学学会越来越认识到儿科医生需要提高评估和治疗行为健康问题的能力。[1]致力于儿科医生行为健康教育的努力增加，显著改善了获得心理健康服务的机会。2接受行为健康问题服务的儿童中有很大一部分现在在初级保健机构接受管理。[3]尽管取得了这些进步，但对儿科医生的调查表明，尽管许多人认识到他们在识别行为健康问题方面的作用，但仍有许多儿科医生没有定期治疗这些疾病。4他们可能不认为治疗是他们的角色，或者他们可能觉得他们缺乏专业知识和时间来提供这些服务。4美国儿科学会2009年定期调查的结果显示，在接受调查的1600名儿科医生中，只有不到三分之一的人认为管理注意力缺陷/多动障碍以外的心理健康问题是他们的职责。[3]尽管有些儿科医生并不认为自己已经准备好提供行为健康护理，或者认为这是他们的职责，但儿科医生拥有许多素质，使他们非常适合提供此类服务。[1]医疗家庭文献也提到了在儿科环境中提供行为和心理健康服务的价值，因为在儿科环境中，耻辱感更少，信任度更高，家庭更熟悉。1，2，5对家庭半结构式访谈进行了定性分析，以了解父母对儿科医生在行为卫生保健方面的作用的期望。这项定性分析是一项混合方法研究的一部分，该研究针对55名父母，他们的孩子由儿科医生转诊接受心理健康护理;这55名父母中的36名参加了半结构化采访。父母被问及他们以前与儿科医生提供行为健康护理的经验，他们认为他们的儿科医生在儿童的行为健康方面扮演什么角色，导致转诊的临床遭遇，以及父母对这些干预措施的反应。这些访谈由3名独立的编码员使用扎根理论方法进行分析。通过分析，出现了一些主题，并根据这些主题编写了一本密码书。通过小组讨论获得了关于主题的共识。一个有趣的主题“家庭真相发现”从访谈中出现，其中一些家庭报告了家庭动力学和家庭结构的变化，通过一次与儿科医生的临床接触。在这份报告中，我们通过详细描述2位父母与儿科医生的临床接触来说明这个过程，我们称之为“家庭真相发现”。儿科医生与孩子和家庭成员的互动有助于揭示家庭中以前不知道的一些真相，改变了在孩子的行为健康症状中发挥作用的家庭动态。
In the past decade, there has been an increasing recognition by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry of the need for pediatricians to improve competencies in assessing and treating behavioral health issues. 1 The increased efforts dedicated to pediatrician education in behavioral health has resulted in significantly improved access to mental health services. 2 A large proportion of children receiving services for behavioral health problems are now managed in primary care settings. 3 Despite these advances, surveys of pediatricians have demonstrated that although many recognize their role in identifying behavioral health problems, there are many pediatricians who are not regularly treating these disorders. 4 They may not see treatment as their role or they may feel they lack the expertise and time to provide these services. 4 Results of the American Academy of Pediatrics 2009 periodic survey revealed that less than one third of the 1600 pediatricians surveyed saw it as their role to manage mental health issues beyond attention deficit/hyperactivity disorder. 3 Although some pediatricians do not feel prepared to provide behavioral health care or see this as their role, pediatricians possess many qualities that make them well suited to provide such services. 1 The medical home literature has also cited the value of providing behavioral and mental health services in the pediatric setting, where there is less stigma, high levels of trust, and more familiarity for families. 1, 2, 5 A qualitative analysis of semistructured interviews with families was conducted to understand the parents’ expectations regarding the role of pediatricians regarding to behavioral health care. This qualitative analysis was part of a mixed-methods study of 55 parents whose children were referred for mental health care by their pediatrician; 36 of these 55 parents participated in a semistructured interview. Parents were asked about their previous experience with the pediatrician providing behavioral health care, what role they see their pediatrician as playing with regard to the child’s behavioral health, the clinical encounter that resulted in a referral, and the parent’s reaction to these interventions. These interviews were analyzed using grounded theory methods by 3 independent coders. Through the analysis, themes emerged, out of which a code book was developed. Consensus regarding the themes was obtained through group discussion.An interesting theme titled “family truth discovery” emerged from the interviews, in which a number of families were reporting changes in the family dynamics and family structure through one clinical encounter with the pediatrician. In this report, we illustrate this process, which we are calling “family truth discovery,” by describing in some detail 2 parents’ accounts of the clinical encounter with the pediatrician. The pediatrician’s interaction with the child and family members was instrumental in revealing some truth in the family that was not known previously, altering the family dynamics that had been playing a role in the child’s behavioral health symptoms.