Aspects of mental health communication skills training that predict parent and child outcomes in pediatric primary care.
OBJECTIVE
Training in communication can change clinician behaviors, but brief training may function by altering attitudes rather than teaching new skills. We used data from a trial of mental health training for office-based primary care to determine indicators of uptake that predicted parent and child outcomes.


METHODS
Clinicians (n=50) were randomized to be controls or receive training. Uptake was determined comparing pre- and post-training visits with standardized patients (SPs) coded for skills and patient centeredness. Clinical outcomes were assessed by recruiting and following 403 children/youth ages 5-16 making visits to participants. At 6 months, change in mental health was assessed by parent and youth reports using the Strengths and Difficulties Questionnaire.


RESULTS
Trained clinicians used more agenda setting, time, and anger management skills than controls and showed increased patient centeredness toward SP parents, but not adolescents. Increased patient-centeredness toward parents predicted improvement in child/youth symptoms and functioning (rated by parents), and improvement in youth-rated symptoms. Increased skills alone were not associated with improvement, but patients of clinicians above the mean for both skill and patient-centeredness change improved most.
Wissow
Lawrence
L
Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA. lwissow@jhsph.edu
Gadomski
Anne
A
Roter
Debra
D
Larson
Susan
S
Lewis
Barry
B
Brown
Jonathan
J
D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data; D003142:Communication; D003156:Community Mental Health Services; D016001:Confidence Intervals; D004219:District of Columbia; D004521:Educational Measurement; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008396:Maryland; D008603:Mental Health; D009518:New York; D018802:Patient-Centered Care; D010372:Pediatrics / Q000193:education*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D011594:Psychometrics; D012017:Referral and Consultation; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
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