Trial of psychosocial training for pediatric generalists

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Background: Community surveys find that from 15-20 percent of school-age children have one or more mental health conditions sufficiently severe to warrant treatment. Even where specialty mental health consultation is available, a substantial proportion of children's mental health problems are identified and treated by generalists. Though many generalist providers are strongly committed to treating mental health problems, evaluations suggest that anywhere from 15 to 40 percent of children identified by generalists get no treatment. Training programs for generalists treating adults show that mental health care can be improved, but these studies have yet to be translated into pediatric settings. Advances in the conceptualization of psychotherapeutic techniques, and evolving knowledge about training physicians in communication skills, provide a strong background on which to base an intervention for pediatricians and family physicians. Methods: Quasi-experimental clinical trial of a two-session, highly interactive, training program involving simulated patients and personalized, structured feedback and analysis of psychosocial skills. The training program is based on a transtheoretical model of psychotherapuetic process, and includes skills related to engaging parents and children, problem identification, solution-focused therapy, and using motivational interviewing to make effective mental health referrals. Population and setting: Approximately 50 mid-career pediatricians and family physicians; approximately 350 children ages 5-17 and their mothers. Two regional, multi-site, multi-specialty staff model practices providing capitated and fee for service care to urban, suburban, and rural populations. Outcome measures: Improvement in child mental health symptoms and functioning (over a 6 month period) measured by a standardized instrument (the Strengths and Difficulties Questionnaire); changes in utilization of pediatric services; utilization of community services; measures of mothers' emotional well-being and of family function.