Translating Cultures of Care: Integrating Behavioral Health Services in Pediatric

University Of California Los Angeles, Los Angeles CA

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Abstract

[unreadable] DESCRIPTION (provided by applicant): This study investigates communication between social workers and pediatricians in the delivery of mental health services in primary care. The investigator will study factors that facilitate and impede communication using qualitative interviews and a survey. Research in this area is important because links between the physical health and mental health systems are weak. In the past decade, there has been a significant increase in the use of psychiatric medication to treat children, prompting debate over whether children are being overmedicated. By better understanding the communication between social workers and pediatricians, there is an opportunity to improve children's outcomes over the lifespan and strengthen ties between the health and mental health systems. Although mental health care for children started out in the 1920s with an emphasis on prevention as well as the diagnosis and treatment of milder emotional and behavioral problems, since then its focus has shifted to severely emotionally disturbed (SED) children and increasing medicalization of mental health issues. Today, the delivery of most mental health services occurs in primary care rather than in agency settings. Many pediatricians have limited mental health training, which complicates the delivery of these services. They frequently encounter children with significant psychosocial problems in practice and these children utilize a high number of health services. Furthermore, once the mental health issue is identified, pediatricians lack relationships with mental health clinicians. Thus, it is difficult for pediatricians to make referrals to children's mental health specialists, and once referred, doctors receive little feedback on mental health treatment progress that could inform physical health treatment. There is a general lack of collaboration between the health and mental health systems. These challenges may be related to issues arising from the separation of the mental health from the health system. For example, the social status of the two professions can hinder communication. Sociologists argue that professions such as medicine use their privileged relationship with the government in order to secure a monopoly over the services they offer, which leads them to dominance and the exclusion of other professions by class and gender (Freidson, 1970b; MacDonald, 1995). While the division of the physical and mental health systems may contribute to collaboration difficulties, there is also evidence that pediatricians and mental health clinicians have found ways to work together. Interdisciplinary team-based models and collaborative work in less hierarchical settings show promise for dealing with the balance of power between the professions. There is also evidence that mental health clinicians and pediatricians have forged relationships with good communication that have extended doctors' mental health skills. In order to study communication between the professions, a mixed method research design will be used. The first phase of the study will be qualitative, semi-structured interviews of pediatricians and social workers to inform the development of a survey instrument that will be used in the second, quantitative phase of the study. The principal investigator will interview up to 30 participants regarding factors that facilitate and impede communication in the professional relationship. The data from these interviews will be used to create a survey instrument that will be pilot tested using a focus group of five social workers. This survey will be sent to a stratified random sample of 600 social workers who are members of the National Association of Social Workers (NASW) in the state of California. [unreadable] [unreadable] Public Health Relevance: Children's mental illnesses have been referred to as a "silent public health epidemic" resulting from stigma and as a result the public health burden is overlooked although it represents a significant challenge (Kaufman, 2007; President's New Freedom Commission on Mental Health, 2003). The promotion of children's emotional well-being and treatment of mental health disorders should be a major public health goal and one easy way to achieve this is to integrate mental health consultation as part of children's primary care (United States Public Health Service-Office of the Surgeon General, 2000). This could result in greater public awareness of children's behavioral health issues, thus leading to the prevention of milder disorders from worsening and improving children's mental health outcomes over the lifespan. [unreadable] [unreadable] [unreadable]