title: Improving child and parent mental health in primary care: a cluster-randomized trial of communication skills training.
abstract: OBJECTIVE
  We examined child and parent outcomes of training providers to engage families efficiently and to reduce common symptoms of a range of mental health problems and disorders.
  
  
  METHODS
  Training involved three 1-hour discussions structured around video examples of family/provider communication skills, each followed by practice with standardized patients and self-evaluation. Skills targeted eliciting parent and child concerns, partnering with families, and increasing expectations that treatment would be helpful. We tested the training with providers at 13 sites in rural New York, urban Maryland, and Washington, DC. Children (5-16 years of age) making routine visits were enrolled if they screened "possible" or "probable" for mental disorders with the Strengths and Difficulties Questionnaire or if their provider said they were likely to have an emotional or behavioral problem. Children and their parents were then monitored for 6 months, to assess changes in parent-rated symptoms and impairment and parent symptoms.
  
  
  RESULTS
  Fifty-eight providers (31 trained and 27 control) and 418 children (248 patients of trained providers and 170 patients of control providers) participated. Among the children, 72% were in the possible or probable categories. Approximately one half (54%) were white, 30% black, 12% Latino, and 4% other ethnicities. Eighty-eight percent (367 children) completed follow-up monitoring. At 6 months, minority children cared for by trained providers had greater reduction in impairment (-0.91 points) than did those cared for by control providers but no greater reduction in symptoms. Seeing a trained provider did not have an impact on symptoms or impairment among white children. Parents of children cared for by trained providers experienced greater reduction in symptoms (-1.7 points) than did those cared for by control providers.
  
  
  CONCLUSIONS
  Brief provider communication training had a positive impact on parent mental health symptoms and reduced minority children's impairment across a range of problems.
authors.affiliation: Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. lwissow@jhsph.edu
authors.forename: Lawrence Sagin
authors.initials: LS
authors.lastname: Wissow
authors.forename: Anne
authors.initials: A
authors.lastname: Gadomski
authors.forename: Debra
authors.initials: D
authors.lastname: Roter
authors.forename: Susan
authors.initials: S
authors.lastname: Larson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Brown
authors.forename: Ciara
authors.initials: C
authors.lastname: Zachary
authors.forename: Edward
authors.initials: E
authors.lastname: Bartlett
authors.forename: Ivor
authors.initials: I
authors.lastname: Horn
authors.forename: Xianghua
authors.initials: X
authors.lastname: Luo
authors.forename: Mei-Cheng
authors.initials: MC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003142:Communication; D004496:Education, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008603:Mental Health; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D010372:Pediatrics / Q000193:education*; D011320:Primary Health Care; D011368:Professional-Family Relations; D011795:Surveys and Questionnaires