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Clinical Pediatrics, Vol. 46, No. 5, 424-430 (2007)
DOI: 10.1177/0009922806297435

Behavioral Health Practices in the Midst of Black Box Warnings and Mental Health Reform

Jane Williams, PhD

Department of Pediatrics, Wake Forest University, janewill{at}wfubmc.edu

Kurt Klinepeter, MD

Department of Pediatrics, Wake Forest University

Guy Palmes, MD

Department of Psychiatry, Wake Forest University

Anita Pulley, MSN, RN

Northwest Area Health Education Center, Winston-Salem, North Carolina

Jane Meschan Foy, MD

Department of Pediatrics, Wake Forest University

A standard guide was readministered to 42 primary care pediatricians after community interventions to assess changes in their behavioral health practices. Among the outcome findings: increased screening of young children (6 months to 5 years); attention deficit hyperactivity disorder continued to be the most frequent diagnosis, with a high level of diagnostic comfort and use of stimulants; decreased comfort in the diagnosis and treatment of depression, with a significant decline in use of selective serotonin reuptake inhibitors; nearly all continued to offer nonmedication, behavioral health treatment; and a significant increase in use of social workers for community referrals. Structured interventions had limited influence on the process of change. Black box warnings exerted a powerful effect on prescribing practices. Systemic changes involving financial incentives, increased access to mental health providers, practice guidelines, and technology for continuing education may offer possibilities for changing practice patterns.

Key Words: children • behavioral health problems • primary care pediatricians


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