Barriers to mental health referral from pediatric primary care settings.
OBJECTIVE
To examine the frequency of barriers to mental health referral according to pediatric primary care physician (PCP) report and to identify factors related to perceptions of referral barriers for patients with managed care coverage.


METHODS
Data from a national sample of 319 PCPs were examined. Comparisons were made concerning the frequency of PCP-reported barriers to mental health referrals for patients with fee-for-service versus managed care coverage. The relationship between relevant factors (eg, practice structure, interdisciplinary office staff, availability of community mental health resources) and perceived barriers was examined for managed care coverage.


RESULTS
Barriers to mental heath referrals were more commonly reported for those with managed care versus fee-for-service coverage for 11 of the 12 barriers assessed (P < .0001). For patients with managed care coverage a high availability of community mental health resources was associated with fewer perceived barriers among physicians (P < .0001).


CONCLUSIONS
Our findings suggest that PCPs perceive barriers to mental health referrals as common challenges when addressing psychosocial concerns. Referral barriers were more commonly reported for patients with managed care coverage. Increasing the availability of community mental health resources was identified as an important variable in facilitating appropriate referrals.
Brown University, Providence, RI, USA. waldersn@njc.org
Natalie
N
Walders
George E
GE
Childs
Diane
D
Comer
Kelly J
KJ
Kelleher
Dennis
D
Drotar
D002648:Child; D018588:Fee-for-Service Plans; D019981:Health Care Sector; D006297:Health Services Accessibility; D006801:Humans; D008329:Managed Care Programs; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000592:standards*; D016012:Poisson Distribution; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States