title: Universal mental health screening in pediatric primary care: a systematic review.
abstract: OBJECTIVE
  Universal mental health screening in pediatric primary care is recommended, but studies report slow uptake and low rates of patient follow-through after referral to specialized services. This review examined possible explanations related to the process of screening, focusing on how parents and youth are engaged, and how providers evaluate and use screening results.
  
  
  METHODS
  A narrative synthesis was developed after a systematic review of 3 databases (plus follow-up of citations, expert recommendations, and checks for multiple publications about the same study). Searching identified 1,188 titles, and of these, 186 full-text articles were reviewed. Two authors extracted data from 45 articles meeting inclusion criteria.
  
  
  RESULTS
  Published studies report few details about how mental health screens were administered, including how clinicians explain their purpose or confidentiality, or whether help was provided for language, literacy, or disability problems. Although they were not addressed directly in the studies reviewed, uptake and detection rates appeared to vary with means of administration. Screening framed as universal, confidential, and intended to optimize attention to patient concerns increased acceptability. Studies said little about how providers were taught to explore screen results. Screening increased referrals, but many still followed negative screens, in some cases because of parent concerns apparently not reflected by screen results but possibly stemming from screen-prompted discussions.
  
  
  CONCLUSIONS
  Little research has addressed the process of engaging patients in mental health screening in pediatric primary care or how clinicians can best use screening results. The literature does offer suggestions for better clinical practice and research that may lead to improvements in uptake and outcome.
authors.affiliation: Johns Hopkins School of Public Health. Electronic address: Lwissow@jhsph.edu.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Wissow
authors.forename: Jonathan
authors.initials: J
authors.lastname: Brown
authors.forename: Kate E
authors.initials: KE
authors.lastname: Fothergill
authors.forename: Anne
authors.initials: A
authors.lastname: Gadomski
authors.forename: Karen
authors.initials: K
authors.lastname: Hacker
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
authors.forename: Rachel
authors.initials: R
authors.lastname: Zelkowitz
mesh_terms: D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008603:Mental Health / Q000592:standards*; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*
keywords: mental health; patient engagement; pediatrics; primary care; screening