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Parents, Providers Often Disagree on Mental Health Counseling
Contact: Jonathan Brown, (202) 264-3446, or Cheryl Pedersen, (609) 275-2258
WASHINGTON, D.C. (January 16, 2009)—Doctors and parents have different perceptions of what takes place in the examining room when it comes to treatment for children’s mental health problems, according to a new article published in Pediatrics. The recent study conducted by Jonathan Brown, a researcher at Mathematica Policy Research, Inc., and Lawrence Wissow, a professor in the Department of Health, Behavior, and Society at the Johns Hopkins Bloomberg School of Public Health, notes that in 75 percent of visits in which pediatric primary care providers said they delivered mental health counseling, parents reported that their children received no such counseling. The report appears in the December 2008 edition of the journal.
The authors examined the results of 749 visits to 54 pediatric primary care providers at 16 practices in Baltimore, Washington, D.C., and rural upstate New York. Patients ranged in age from 5 to 16; about a quarter had high levels of mental health symptoms. The providers included 44 physicians, nine nurse practitioners, and one physician assistant.
Parents were less likely to agree that the provider delivered mental health counseling when the provider felt burdened by treating mental health problems or felt disconnected from other mental health providers. According to Brown, provider burden includes “feeling anxious about spending too much time on mental health problems or that treating mental health problems causes other disruptions to their practices.” When providers lack ready access to specialists who can provide assistance, they might not deliver a level of care that parents recognize as counseling. “Finding strategies to reduce provider burden and increase accessibility to specialists may help to improve providers’ ability to deliver services that parents perceive as counseling,” added Brown.
After a patient visit, providers and parents both answered a yes-or-no question about receipt of mental health counseling during the visit. Parents indicated whether the provider counseled them about their child’s mood, behavior, ability to get along with others, parental stresses, or family problems. Providers indicated whether they had given counseling for a mental health problem requiring clinical attention.
Providers indicated that they had delivered mental health counseling during 32 percent of the visits, but parents reported receiving counseling only 11 percent of the time. According to Brown, the study’s findings underscore the need for further research on the quality of mental health counseling delivered in pediatric primary care. However, providers may be able to engage in a few simple steps to increase the likelihood that treatment meets parents’ expectations.
“Parents may be more likely to perceive treatment as mental health counseling if providers first elicit mental health concerns at the beginning of a visit, explain how those concerns will be addressed, and then conclude the visit by checking in with families to ensure that the parent’s concerns have been addressed,” said Brown.
Brown’s work and the original data collection were funded by grants from the National Institute of Mental Health.
Mathematica, a nonpartisan research firm, conducts high-quality, objective policy research and surveys to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Washington, D.C., Cambridge, Mass., Ann Arbor, Mich., and Oakland, Calif., has conducted some of the most important studies of health care, education, welfare, employment, nutrition, and early childhood policies and programs in the United States.