Does Extra Training Improve Rates of Care of Behavioral and Mental Health Issues?

Ruth E.K. Stein, MD, Sarah McCue Horotwitz, PhD,Robert B. Penfold, PhD, Lynn Olson, PhD, Kelly Kelleher, MD, Amy Heneghan, MD, Elyse Park, PhD, Kimberly Hoagwood, MD

 

Background:  Pediatricians have repeatedly reported that they have inadequate training in behavioral and developmental pediatrics and are poorly equipped to treat these conditions.

 

Objective: To test hypotheses that pediatricians who have advanced training in behavioral and development pediatrics, child psychiatry and related fields would identify and treat more psychosocial issues and would be less likely to refer patients with those conditions to other providers.

 

Design/Methods: Data were obtained from the American Academy of Pediatrics Periodic Survey #59.  Of non-trainee members 745 (57%) responded to questions on identifying, treating and referring children and mothers with a wide range of behavioral issues (e.g. ADHD, depression, LD, Anxiety etc.).  Respondents were dichotomized into those with and without fellowship-level training in Behavioral-Developmental Pediatrics, Child Psychiatry, Adolescent Medicine4, or Behavioral Science.

 

Results: 26.7% of respondents reported that they had fellowship training in one of the listed specialties:  Behavior-Development (17%), Child Psychiatry (10%), suggesting response bias in return of questionnaires.  7-16.4% higher rates of usually asking questions about child behavioral issues across conditions were found among those with advanced training; smaller differences were reported in rates of identification of maternal problems.  Advanced training was associated with small differences in proportion reporting that they usually treat the child?s condition:  overall rates range from 4-8% higher, except for ADHD which 57% both groups usually treat.  The highest rates for treating any of the other conditions by those with advanced training was 24.5% for behavior problems and 21% for anxiety disorders.  Referral rates did not differ by training.  There were minimal differences in rates of treating maternal issues.

 

Conclusions: Even in this sample with unusually high levels of reported training in behavioral and developmental issues, it appears that advanced training is associated with small differences in reporting and identification of child behavioral issues and of treating these conditions.  Although most of these pediatricians trained before standardization of fellowships, these data raise concern about this mechanism of increasing services for child behavioral issues.