title: Do On-Site Mental Health Professionals Change Pediatricians' Responses to Children's Mental Health Problems?
abstract: To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems.
  
  
  
  Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed.
  
  
  
  Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, <100 visits per week, <80% of patients privately insured) and interactions of practice location (urban) with visits and patient insurance were associated with on-site MHPs. There was no overall association between colocation and comanagement, or whether pediatricians usually identified, treated/managed, or referred 5 common child MH problems. Among the subset of pediatricians who reported comanaging, there was an association with comanagement when the on-site MHP was a child psychiatrist, substance abuse counselor, or social worker.
  
  
  
  On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY. Electronic address: Sarah.horwitz@nyumc.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: McCue Horwitz
authors.affiliation: Statistical Research Consultants, LLC, Schaumburg, Ill.
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; Nathan Kline Institute of Psychiatric Research, Orangeburg, NY.
authors.forename: Bonnie D
authors.initials: BD
authors.lastname: Kerker
authors.affiliation: University of California at Los Angeles, Los Angeles, Calif.
authors.forename: Moira
authors.initials: M
authors.lastname: Szilagyi
authors.affiliation: Case Western Reserve University, School of Medicine, Cleveland, Ohio.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Garner
authors.affiliation: American Academy of Pediatrics, Elk Grove Village, Ill.
authors.forename: Karen G
authors.initials: KG
authors.lastname: O'Connor
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Hoagwood
authors.affiliation: New York-Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
authors.forename: Cori M
authors.initials: CM
authors.lastname: Green
authors.affiliation: Wake Forest University School of Medicine, Winston Salem, NC.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Foy
authors.affiliation: Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, NY.
authors.forename: Ruth E K
authors.initials: RE
authors.lastname: Stein
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D000072143:Pediatricians; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011570:Psychiatry; D011584:Psychology; D012017:Referral and Consultation; D000068217:Social Workers
keywords: child psychosocial problems; on-site mental health; primary care