Skip to main content

Advertisement

SpringerLink
Log in

A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care

  • Original Paper
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

To expand the mental health service capacity of pediatric primary care, we ask whether there are evidence-based skills to allow providers to 1) immediately begin treatment for children with emotional and behavioral problems while diagnostic procedures are being pursued, and 2) offer evidence-based care to children who do not meet criteria for a specific diagnosis. We discuss why the epidemiology of child mental health problems poses difficulties for disorder-specific mental health interventions, and review evidence that “common factors” contributing to the outcome of mental health treatments define a core set of skills that primary care providers might use to complement disorder-specific interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Angold, A., Costello, E. J., Farmer, E. M., Burns, B. J., & Erkanli, A. (1999). Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry, 38(2), 129–137.

    Article  PubMed  CAS  Google Scholar 

  • Asarnow, J. R., Jaycox, L. H., Duan, N., LaBorde, A. P., Rea, M. M., Murray, P., et al. (2005). Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: A randomized controlled trial. The Journal of the American Medical Association, 293(3), 311–319.

    Article  CAS  Google Scholar 

  • Beach, M. C., Inui, T., & The Relationship-Centered Care Research Network. (2005). Relationship-centered care: A constructive reframing. Journal of General Internal Medicine, 21, S3–S8.

    Article  Google Scholar 

  • Bernal, P., Estroff, D. B., Aboudarham, J. F., Murphy, M., Keller, A., & Jellinek, M. S. (2000). Psychosocial morbidity: The economic burden in a pediatric health maintenance organization sample. Archives of Pediatrics and Adolescent Medicine, 154(3), 261–266.

    PubMed  CAS  Google Scholar 

  • Beutler, L. E., Castonguay, L. G., & Follette, W. C. (2006). Therapeutic factors in dysphoric disorders. Journal of Clinical Psychology, 62(6), 639–647.

    Article  PubMed  Google Scholar 

  • Bickman, L. (2005). A common factors approach to improving mental health services. Mental Health Services Research, 7(1), 1–4.

    Article  PubMed  Google Scholar 

  • Blanchard, L. T., Gurka, M. J., & Blackman, J. A. (2006). Emotional, developmental, and behavioral health of American children and their families: A report from the 2003 National Survey of Children’s Health. Pediatrics, 117(6), e1202–e1212.

    Article  PubMed  Google Scholar 

  • Briggs-Gowan, M. J., Horwitz, S. M., Schwab-Stone, M. E., Leventhal, J. M., & Leaf, P. J. (2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. Journal of the American Academy of Child and Adolescent Psychiatry, 39(7), 841–849.

    Article  PubMed  CAS  Google Scholar 

  • Briggs-Gowan, M. J., Owens, P. L., Schwab-Stone, M. E., Leventhal, J. M., Leaf, P. J., & Horwitz, S. M. (2003). Persistence of psychiatric disorders in pediatric settings. Journal of the American Academy of Child and Adolescent Psychiatry, 42(11), 1360–1369.

    Article  PubMed  Google Scholar 

  • Britt, E., Hudson, S. M., & Blampied, N. M. (2004). Motivational interviewing in health settings: A review. Patient Education and Counseling, 53(2), 147–155.

    Article  PubMed  Google Scholar 

  • Brown, J. D., Riley, A. W., & Wissow, L. (2007a). Identification of youth psychosocial problems during pediatric primary care visits. Administration and Policy in Mental Health, 34(3), 269–281.

    Article  PubMed  Google Scholar 

  • Brown, J. D., Wissow, L. S., Gadomski, A., Zachary, C., Bartlett, E., & Horn, I. (2006). Parent and teacher mental health ratings of children using primary-care services: Inter-rater agreement and implications for mental health screening. Ambulatory Pediatrics, 6(6), 347–351.

    Article  PubMed  Google Scholar 

  • Brown, J. D., Wissow, L. S., & Riley, A. W. (2007b). Physician and patient characteristics associated with discussion of psychosocial health during pediatric primary care visits. Clinical Pediatrics (Philadelphia), 46(9), 812–820.

    Article  Google Scholar 

  • Brown, J. D., Wissow, L. S., Zachary, C., & Cook, B. L. (2007c). Receiving advice about child mental health from a primary care provider: African American and Hispanic parent attitudes. Medical Care, 45(11), 1076–1082.

    PubMed  Google Scholar 

  • Bussing, R., Koro-Ljungberg, M. E., Gary, F., Mason, D. M., & Garvan, C. W. (2005). Exploring help-seeking for ADHD symptoms: A mixed-methods approach. Harvard Review of Psychiatry, 13(2), 85–101.

    Article  PubMed  Google Scholar 

  • Campo, J. V., Shafer, S., Strohm, J., Lucas, A., Cassesse, C. G., Shaeffer, D., et al. (2005). Pediatric behavioral health in primary care: A collaborative approach. Journal of the American Psychiatric Nurses Association, 11(5), 276–282.

    Article  Google Scholar 

  • Castonguay, L. G., & Beutler, L. E. (2006). Principles of therapeutic change: A task force on participants, relationships, and techniques factors. Journal of Clinical Psychology, 62(6), 631–638.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20.

    Article  PubMed  Google Scholar 

  • Cornuz, J., Humair, J. P., Seematter, L., Stoianov, R., van Melle, G., Stalder, H., et al. (2002). Efficacy of resident training in smoking cessation: A randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients. Annals of Internal Medicine, 136(6), 429–437.

    PubMed  Google Scholar 

  • Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.

    Article  PubMed  Google Scholar 

  • Costello, E. J., Pescosolido, B. A., Angold, A., & Burns, B. J. (1998). A family network-based model of access to child mental health services. Research in Community and Mental Health, 9, 165–190.

    Google Scholar 

  • Costello, E. J., & Shugart, M. A. (1992). Above and below the threshold: severity of psychiatric symptoms and functional impairment in a pediatric sample. Pediatrics, 90(3), 359–368.

    PubMed  CAS  Google Scholar 

  • Dew, S. E., & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7(1), 21–32.

    Article  PubMed  Google Scholar 

  • Dunst, C. J., Trivette, C. M., & Deal, A. G. (1988). Enabling and empowering families: Principles and guidelines for practice. Cambridge, MA: Brookline Books.

    Google Scholar 

  • Epner, J. E., Levenberg, P. B., & Schoeny, M. E. (1998). Primary care providers’ responsiveness to health-risk behaviors reported by adolescent patients. Archives of Pediatric & Adolescent Medicine, 152(8), 774–780.

    CAS  Google Scholar 

  • Evidence Based Services Committee. (2004). Summary of effective interventions for youth with behavioral and emotional needs. Hawaii Department of Health, Child and Adolescent Mental Health Division.

  • Fallowfield, L., Jenkins, V., Farewell, V., & Solis-Trapala, I. (2003). Enduring impact of communication skills training: Results of a 12-month follow-up. British Journal of Cancer, 89(8), 1445–1449.

    Article  PubMed  CAS  Google Scholar 

  • Finset, A., Ekeberg, O., Eide, H., & Aspergren, K. (2003). Long-term benefits of communication skills training for cancer doctors. Psychooncology, 12(7), 686–693.

    Article  PubMed  Google Scholar 

  • Gardner, W., Kelleher, K. J., Pajer, K. A., & Campo, J. V. (2003). Primary care clinicians’ use of standardized tools to assess child psychosocial problems. Ambulatory Pediatrics, 3(4), 191–195.

    Article  PubMed  Google Scholar 

  • Getrich, C., Heying, S., Willging, C., & Waitzkin, H. (2007). An ethnography of clinic “noise” in a community-based promotora-centered mental health intervention. Social Science and Medicine, 65(2), 319–330.

    Article  PubMed  Google Scholar 

  • Goldberg, D., Sharp, D., & Nanayakkara, K. (1995). The field trial of the mental disorders section of ICD-10 designed for primary care (ICD10-PHC) in England. Family Practice, 12(4), 466–473.

    Article  PubMed  CAS  Google Scholar 

  • Grencavage, L. M., & Norcross, J. C. (1990). Where are the commonalities among the therapeutic common factors? Professional Psychology: Research and Practice, 21(5), 372–378.

    Article  Google Scholar 

  • Hawley, K. M., & Weisz, J. R. (2005). Youth versus parent working alliance in usual clinical care: Distinctive associations with retention, satisfaction, and treatment outcome. Journal of Clinical Child and Adolescent Psychology., 34(1), 117–128.

    Article  PubMed  Google Scholar 

  • Horvath, A. O. (2000). The therapeutic relationship: From transference to alliance. Journal of Clinical Psychology, 56(2), 163–173.

    Article  PubMed  CAS  Google Scholar 

  • Horwitz, S. M., Gary, L. C., Briggs-Gowan, M. J., & Carter, A. S. (2003). Do needs drive services use in young children? Pediatrics, 112(6 Pt. 1), 1373–1378.

    Article  PubMed  Google Scholar 

  • Horwitz, S. M., Kelleher, K. J., Stein, R. E., Storfer-Isser, A., Youngstrom, E. A., Park, E. R., et al. (2007). Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics, 119(1), e208–e218.

    Article  PubMed  Google Scholar 

  • Horwitz, S. M., Leaf, P. T., & Leventhal, J. M. (1998). Identification of psychosocial problems in pediatric primary care: Do family attitudes make a difference? Archives of Pediatric and Adolescent Medicine, 152(4), 367–371.

    CAS  Google Scholar 

  • Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2005). A theoretical model of common process factors in youth and family therapy. Mental Health Services Research, 7(1), 35–51.

    Article  PubMed  Google Scholar 

  • Karver, M. S., Handeslman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, (1), 50–65.

  • Katon, W., Unutzer, J., Fan, M. Y., Williams, J. W., Jr, Schoenbaum, M., Lin, E. H., et al. (2006). Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes care, 29(2), 265–270.

    Article  PubMed  Google Scholar 

  • Kilbourne, A. M., Schulberg, H. C., Post, E. P., Rollman, B. L., Belnap, B. H., & Pincus, H. A. (2004). Translating evidence-based depression management services to community-based primary care practices. Milbank Quarterly, 82(4), 631–659.

    Article  PubMed  Google Scholar 

  • Kramer, T., & Garralda, M. E. (1998). Psychiatric disorders in adolescents in primary care. British Journal of Psychiatry, 173, 508–513.

    Article  PubMed  CAS  Google Scholar 

  • Lambert, M. J., & Barley, D. E. (2002). Research summary on the therapeutic relationship and psychotherapy outcome. In J. C. Norcross (Ed.), Psychotherapy relationships that work: therapist contributions and responsiveness of patients (pp. 17–32). Oxford: Oxford University Press.

    Google Scholar 

  • Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould, C., et al. (2001). Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ, 323(7318), 908–911.

    Article  PubMed  CAS  Google Scholar 

  • López-Stewart, C., Lara, M. G., Amighetti, L. D., Wissow, L. S., Guttierez, M. I., Levav, I., et al. (2000). Parenting and physical punishment: Primary care interventions in Latin America. Pan American Journal of Public Health, 8(4), 257–267.

    PubMed  Google Scholar 

  • McKay, M. M., McCadam, K., & Gonzales, J. (1996). Addressing barriers to mental health services for inner-city children and their caretakers. Community Mental Health Journal, 32(4), 353–361.

    Article  PubMed  CAS  Google Scholar 

  • Miller, W. R., & Mount, K. A. (2001). A small study of training in motivational interviewing: Does one workshop change clinician and client behavior? Behavioural & Cognitive Psychotherapy, 29(4), 457–471.

    Article  Google Scholar 

  • Minkovitz, C. S., Strobino, D., Scharfstein, D., Hou, W., Miller, T., Mistry, K. B., et al. (2005). Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics, 115(2), 306–314.

    Article  PubMed  Google Scholar 

  • Moses, E. B., & Barlow, D. H. (2006). A new unified treatment approach for emotional disorders based on emotion science. Current Directions in Psychological Science, 15(3), 146–150.

    Article  Google Scholar 

  • Olson, A. L., Kelleher, K. J., Kemper, K. J., Zuckerman, B. S., Hammond, C. S., & Dietrich, A. J. (2001). Primary care pediatricians’ roles and perceived responsibilities in the identification and management of depression in children and adolescents. Ambulatory Pediatrics, 1(2), 91–98.

    Article  PubMed  CAS  Google Scholar 

  • Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., et al. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, 370(9591), 991–1005.

    Article  PubMed  Google Scholar 

  • Pill, R., Stott, N. C. H., Rollnick, S. R., & Rees, M. (1998). A randomized trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: Patient outcomes and professional ability to change behavior. Family Practice, 15(3), 229–235.

    Article  PubMed  CAS  Google Scholar 

  • Pyne, J. M., Rost, K. M., Farahati, F., Tripathi, S. P., Smith, J., Williams, D. K., et al. (2005). One size fits some: The impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention. Psychological Medicine, 35(6), 839–854.

    Article  PubMed  Google Scholar 

  • Reinschmidt, K. M., Hunter, J. B., Fernández, M. L., Lacy-Martínez, C. R., de Zapein, J. G., & Meister, J. (2006). Understanding the success of promotoras in increasing chronic disease screening. Journal of Health Care for the Poor and Uninsured., 17(2), 256–264.

    Article  Google Scholar 

  • Resnicow, K., Davis, R., & Rollnick, S. (2006). Motivational interviewing for pediatric obesity: conceptual issues and evidence review. Journal of the American Dietetic Association, 106(12), 2024–2033.

    Article  PubMed  Google Scholar 

  • Riley, A. W., Finney, J. W., Mellits, E. D., Starfield, B., Kidwell, S., Quaskey, S., et al. (1993). Determinants of children’s health care use: An investigation of psychosocial factors. Medical Care, 31(9), 767–783.

    Article  PubMed  CAS  Google Scholar 

  • Rishel, C. W., Greeno, C. G., Marcus, S. C., & Anderson, C. (2006). Effect of maternal mental health problems on child treatment response in community-based services. Psychiatric Services, 57(5), 716–719.

    Article  PubMed  Google Scholar 

  • Rost, K., Nutting, P. A., Smith, J., & Werner, J. J. (2000). Designing and implementing a primary care intervention trial to improve the quality and outcome of care for major depression. General Hospital Psychiatry, 22(2), 66–77.

    Article  PubMed  CAS  Google Scholar 

  • Roter, D. L., Hall, J. A., Kern, D. E., Barker, L. R., Cole, K. A., & Roca, R. P. (1995). Improving physicians’ interviewing skills and reducing patients’ emotional distress. Archives of Internal Medicine, 155(17), 1877–1884.

    Article  PubMed  CAS  Google Scholar 

  • Rushton, J., Bruckman, D., & Kelleher, K. (2002). Primary care referral of children with psychosocial problems. Archives of Pediatrics and Adolescent Medicine, 156(6), 592–598.

    PubMed  Google Scholar 

  • Sarvet, B. (2006). The Massachusetts Child Psychiatry Access Project. AACAP News. July-August,208–209.

  • Schoenbaum, M., Unutzer, J., Sherbourne, C., Duan, N., Rubenstein, L. V., Miranda, J., et al. (2001). Cost-effectiveness of practice-initiated quality improvement for depression: Results of a randomized controlled trial. Journal of the American Medical Association, 286(11), 1325–1330.

    Article  PubMed  CAS  Google Scholar 

  • Simon, G. E., Katon, W. J., Lin, E. H., Rutter, C., Manning, W. G., Von Korff, M., et al. (2007). Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of General Psychiatry, 64(1), 65–72.

    Article  PubMed  Google Scholar 

  • Simon, G. E., Katon, W. J., VonKorff, M., Unutzer, J., Lin, E. H., Walker, E. A., et al. (2001). Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. American Journal of Psychiatry, 158(10), 1638–1644.

    Article  PubMed  CAS  Google Scholar 

  • Sindelar, H. A., Abrantes, A. M., Hart, C., Lewander, W., & Spirito, A. (2004). Motivational interviewing in pediatric practice. Current Problems in Pediatric and Adolescent Health Care, 34(9), 322–339.

    Article  PubMed  Google Scholar 

  • Starfield, B. (1980). Continuous confusion? American Journal of Public Health, 70(2), 117–119.

    PubMed  CAS  Google Scholar 

  • Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Research, 6(4), 189–198.

    Article  PubMed  Google Scholar 

  • Tevyaw, T. O., & Monti, P. M. (2004). Motivational enhancement and other brief interventions for adolescent substance abuse: Foundations, applications, and evaluations. Addiction, 99(Suppl. 2), 63–75.

    Article  PubMed  Google Scholar 

  • Thom, D. H., Kravitz, R. L., Bell, R. A., Krupat, E., & Azari, R. (2002). Patient trust in the physician: Relationship to patient requests. Family Practice, 19(5), 476–483.

    Article  PubMed  Google Scholar 

  • Tonb, D. C., Horwitz, S. M., & Leaf, P. J. (1999). Mental health factors in the utilization of pediatric primary care. Mental Health Services Research, 1(1), 47–57.

    Article  Google Scholar 

  • Von Korff, M., Katon, W., Bush, T., Lin, E. H., Simon, G. E., Saunders, K., et al. (1998). Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosomatic Medicine, 60(2), 143–149.

    Google Scholar 

  • Wagner, E. H., Austin, B. T., & Von Korff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly, 74(4), 511–544.

    Article  PubMed  CAS  Google Scholar 

  • Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62(6), 603–613.

    Article  PubMed  Google Scholar 

  • Wiley, C. C., Burke, G. S., Gill, P. A., & Law, N. E. (2004). Pediatricians’ views of postpartum depression: A self-administered survey. Archives of Women’s Mental Health, 7(4), 231–236.

    Article  PubMed  CAS  Google Scholar 

  • Williams, J., Shore, S. E., & Foy, J. M. (2006). Co-location of mental health professionals in primary care settings: Three North Carolina models. Clinical Pediatrics (Philadelphia), 45(6), 537–543.

    Article  Google Scholar 

  • Wissow, L. S., Gadomski, A., Roter, D., Larson, S., Horn, I., Bartlett, E., et al. (2008). A cluster-randomized trial of mental health communication skills for pediatric generalists. Pediatrics., 121(2), 266–275.

    Article  PubMed  Google Scholar 

  • Wissow, L. S., Roter, D., Bauman, L. J., Crain, E., Kercsmar, C., Weiss, K., et al. (1998). Patient-provider communication during the emergency department care of children with asthma. The National Cooperative Inner-City Asthma Study, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD. Medical Care, 36(10), 1439–1450.

    Article  PubMed  CAS  Google Scholar 

  • Wissow, L. S., Roter, D., & Larson, S. (2003). Longitudinal care improves disclosure of psychosocial information. Archives of Pediatrics and Adolescent Medicine, 157(5), 419–425.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2005). Atlas: child and adolescent mental health resources. Geneva: World Health Organization.

    Google Scholar 

Download references

Acknowledgments

LW, JB, and AG collaborated (with others) on a trial of what turned out to be a common process approach to training pediatric primary care providers to address mental health problems (funded by NIMH grant RO1MH62469, as is the work on this paper). BA, SD, GG, MR, and LW have spent many hours discussing ways of delivering evidence-based mental health services in pediatric primary care. LW and AG have benefited enormously from being able to sit in on discussions of the American Academy of Pediatrics’ Task Force on Mental Health, led by Dr. Jane Foy.

Author information

Authors and Affiliations

  1. Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Larry Wissow, Susan DosReis, Golda Ginsburg & Mark Riddle

  2. Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 703 Hampton House, 624 N. Broadway, Baltimore, MD, 21205, USA

    Larry Wissow

  3. Georgetown University, Washington, DC, USA

    Bruno Anthony

  4. Mathematica Policy Research, Washington, DC, USA

    Jonathan Brown

  5. Bassett Healthcare, Cooperstown, NY, USA

    Anne Gadomski

Authors
  1. Larry Wissow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruno Anthony
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan DosReis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Gadomski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Golda Ginsburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mark Riddle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Larry Wissow.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wissow, L., Anthony, B., Brown, J. et al. A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care. Adm Policy Ment Health 35, 305–318 (2008). https://doi.org/10.1007/s10488-008-0178-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-008-0178-7

Keywords

Search

Navigation