title: Mental health screening and consultation in primary care: The role of child age and parental concerns [corrected].
abstract: OBJECTIVE
  To determine (1) how child age relates to parent concerns about child behavior and (2) how child age and parent concerns correlate with provider referrals and family attendance at mental health consultant (MHC) appointments.
  
  
  METHODS
  Data were obtained from Rhode Island's Project, Linking Actions for Unmet Needs in Children's Health, in which universal developmental and behavioral screening and MHCs were embedded within primary care sites serving low-income diverse families. Children 9 months to 8 years of age were eligible for the study if they had a scheduled screening well-child visit in 2010 (N = 1451). Families completing screening and/or those referred for a MHC appointment were included in analyses (n = 700). Outcome measures included parent-reported concerns about child behavior, referral status following screening, and family attendance at the MHC appointment.
  
  
  RESULTS
  For every 1-month increase in child age, there was a 1.02 times increase in the likelihood of parent behavioral concern and a 1.04 times increase in the likelihood of mental health referral, even when controlling for child behavior. MHC-referred children older than 5 years were 2.61 times more likely to attend than children less than 5 years. When examining parent behavioral concerns and child age jointly, only concerns remained significant.
  
  
  CONCLUSIONS
  Infants and toddlers, who have the highest rates of unmet mental health needs, may be least likely to benefit from universal screening and on-site MHC support. Efforts to incorporate behaviorally based screening tools and increase parent concerns where appropriate appear warranted, particularly for families with very young children.
authors.affiliation: *Child Health Advocacy Institute, Children's National Health System, Washington, DC; †University of Massachusetts, Department of Psychology, Boston, MA; ‡Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Leandra
authors.initials: L
authors.lastname: Godoy
authors.forename: Alice S
authors.initials: AS
authors.lastname: Carter
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: Silver
authors.forename: Susan
authors.initials: S
authors.lastname: Dickstein
authors.forename: Ronald
authors.initials: R
authors.lastname: Seifer
mesh_terms: D000367:Age Factors; D002653:Child Behavior Disorders / Q000175:diagnosis; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010290:Parents / Q000523:psychology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012237:Rhode Island / Q000453:epidemiology; D011795:Surveys and Questionnaires