ABSTRACT
Presented at the Pediatric Academic Societies annual meeting, May 2005
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.