title: Aspects of mental health communication skills training that predict parent and child outcomes in pediatric primary care.
abstract: 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.
authors.affiliation: Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA. lwissow@jhsph.edu
authors.forename: Lawrence
authors.initials: L
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: Barry
authors.initials: B
authors.lastname: Lewis
authors.forename: Jonathan
authors.initials: J
authors.lastname: Brown
mesh_terms: 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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