Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1896-1906 (doi:10.1542/peds.2006-0026)
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ARTICLE

Mental Health Screening in Pediatric Practice: Factors Related to Positive Screens and the Contribution of Parental/Personal Concern

Karen A. Hacker, MD, MPHa,b, Enkhbolor Myagmarjav, MPHa, Victoria Harris, MSW, MPHa, Shakira Franco Suglia, MSa, Deborah Weidner, MDc,d and David Link, MDe,f

a Institute for Community Health
c Child Psychiatry Ambulatory Services
e Department of Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts
b Departments of Medicine
d Psychiatry
f Pediatrics, Harvard Medical School, Boston, Massachusetts

OBJECTIVES. The goals were to examine factors related to positive Pediatric Symptom Checklist scores in an urban practice and to examine the relative contribution of parental/personal concern about emotional and behavioral problems to mental health problem identification.

METHODS. Annual screening using the Pediatric Symptom Checklist was implemented in Cambridge Pediatrics (Cambridge, MA). A social worker was colocated in the clinic to provide therapeutic interventions for patients. A sample of 1668 screened patients between 4 years 11 months and 19 years of age was used for analysis. Bivariate and multivariate analyses were conducted to determine factors predictive of positive Pediatric Symptom Checklist scores, including demographics, socioeconomic indicators, enrollment in counseling, and parental/personal concern. Parental/personal concern, counseling, and positive Pediatric Symptom Checklist scores were examined to determine their efficacy as screening methods.

RESULTS. Six percent of the population had positive Pediatric Symptom Checklist scores. There were statistically significant relationships between a positive score and being in counseling, parental/personal concern, having public insurance, and living in an area with median household incomes of less than $50000. Parental/personal concern was 40% sensitive for a positive score. A positive Pediatric Symptom Checklist score with or without parental/personal concern identified 3.8% of the population; parental/personal concern with or without a positive Pediatric Symptom Checklist score identified 4.5%.

CONCLUSIONS. Mental health screening can be effectively implemented in a pediatric practice. Colocated mental health professionals provide additional support. The combination of a screening tool and questions about parental/personal concern and present counseling can provide critical information about a child’s mental health.

Key Words: mental health • screening • Pediatric Symptom Checklist

Abbreviations: PSC—Pediatric Symptom Checklist • Y-PSC—Youth-Pediatric Symptom Checklist • OR—odds ratio • CI—confidence interval

Accepted Jun 2, 2006.




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