Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. 266-275 (doi:10.1542/10.1542/peds.2007-0418)

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ARTICLE

Improving Child and Parent Mental Health in Primary Care: A Cluster-Randomized Trial of Communication Skills Training

Lawrence Sagin Wissow, MD, MPH^a, Anne Gadomski, MD, MPH^b, Debra Roter, DrPH^a, Susan Larson, MS^a, Jonathan Brown, PhD, MHS^c, Ciara Zachary, BA^a, Edward Bartlett, MD^d, Ivor Horn, MD, MPH^e, Xianghua Luo, PhD^f and Mei-Cheng Wang, PhD^f

^a Departments of Health, Behavior, and Society
^c Health, Policy, and Management
^f Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
^b Department of Pediatrics, Bassett Healthcare, Cooperstown, New York
^d Department of Pediatrics, Johns Hopkins Community Physicians, Baltimore, Maryland
^e Department of Pediatrics, Children's National Medical Center, Washington, DC

OBJECTIVE. We examined child and parent outcomes of training providers to engage families efficiently and to reduce common symptoms of a range of mental health problems and disorders.

METHODS. Training involved three 1-hour discussions structured around video examples of family/provider communication skills, each followed by practice with standardized patients and self-evaluation. Skills targeted eliciting parent and child concerns, partnering with families, and increasing expectations that treatment would be helpful. We tested the training with providers at 13 sites in rural New York, urban Maryland, and Washington, DC. Children (5–16 years of age) making routine visits were enrolled if they screened "possible" or "probable" for mental disorders with the Strengths and Difficulties Questionnaire or if their provider said they were likely to have an emotional or behavioral problem. Children and their parents were then monitored for 6 months, to assess changes in parent-rated symptoms and impairment and parent symptoms.

RESULTS. Fifty-eight providers (31 trained and 27 control) and 418 children (248 patients of trained providers and 170 patients of control providers) participated. Among the children, 72% were in the possible or probable categories. Approximately one half (54%) were white, 30% black, 12% Latino, and 4% other ethnicities. Eighty-eight percent (367 children) completed follow-up monitoring. At 6 months, minority children cared for by trained providers had greater reduction in impairment (–0.91 points) than did those cared for by control providers but no greater reduction in symptoms. Seeing a trained provider did not have an impact on symptoms or impairment among white children. Parents of children cared for by trained providers experienced greater reduction in symptoms (–1.7 points) than did those cared for by control providers.

CONCLUSION. Brief provider communication training had a positive impact on parent mental health symptoms and reduced minority children's impairment across a range of problems.

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Key Words: mental health • children • parents • primary care

Abbreviations: GHQ—General Health Questionnaire • SDQ—Strengths and Difficulties Questionnaire • CI—confidence interval

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Accepted Jul 23, 2007.

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