title: Which Pediatricians Comanage Mental Health Conditions?
abstract: Given the prevalence of mental health (MH) conditions (MHC) in children, pediatricians should initiate treatment alone or in collaboration with a specialist for children with MHC. However, the majority of pediatricians do not manage or comanage common MHC even with an on-site MH provider. We examined which physician, practice, and training characteristics are associated with pediatricians' comanaging at least half of their patients with MHC.
  
  
  
  We analyzed responses of general pediatricians (n = 305) from the American Academy of Pediatrics 2013 Periodic Survey. Practice characteristics include presence of an on-site MH provider and perceived access to services. Independent variables included sociodemographics, training experiences, and interest in further training. The outcome was comanagement of ≥50% of patients with MHC. Weighted univariate, bivariate, and multivariable analyses were performed.
  
  
  
  Of the pediatricians who reported comanaging ≥50% of their patients with MHC, logistic regression analysis showed that pediatricians who completed ≥4 weeks of developmental behavioral pediatrics training had 1.8 increased odds (95% confidence interval 1.06, 3.08, P = .03) of comanagement, those very interested in further education in managing/treating MHC had 2.75 increased odds (95% confidence interval 1.63, 3.08, P < .001), and those with more training in MH treatment with medications had 1.4 increased odds (95% confidence interval 1.12, 1.75, P = .004) of comanaging children with MHC.
  
  
  
  Specific educational experiences and interest in further education in managing or treating MHC were significantly associated with comanaging ≥50% of patients, suggesting that enhanced MH training among pediatricians could increase the comanagement of children with MHC.
authors.affiliation: General Academic Pediatrics, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY. Electronic address: cmg9004@med.cornell.edu.
authors.forename: Cori
authors.initials: C
authors.lastname: Green
authors.affiliation: Statistical Research Consultants, Schaumburg, Ill.
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.affiliation: General Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY.
authors.forename: Ruth E K
authors.initials: REK
authors.lastname: Stein
authors.affiliation: Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Garner
authors.affiliation: Nathan Kline Institute for Psychiatric Research, Orangeburg, NY; Department of General Pediatrics, New York University School of Medicine, New York, NY.
authors.forename: Bonnie D
authors.initials: BD
authors.lastname: Kerker
authors.affiliation: Department of Pediatrics, University of California at Los Angeles, Los Angeles, Calif.
authors.forename: Moira
authors.initials: M
authors.lastname: Szilagyi
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 General Pediatrics, New York University School of Medicine, New York, NY.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Hoagwood
authors.affiliation: Department of General Pediatrics, New York University School of Medicine, New York, NY.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010372:Pediatrics; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation
keywords: behavior problems; comanagement mental health; developmental behavioral pediatrics; pediatric education learning problems