Psychosocial Problems During Child Health Supervision Visits: Eliciting, Then What?
From the Department of Counseling, Sonoma State University, Rohnert Park, CA
From the Department of Pediatrics, University of California, San Francisco
An explicit goal of child health supervision visits is to gather information and provide guidance about the psychosocial problems of children and families. The purpose of this study was to determine the extent to which parents had opportunities to express psychosocial concerns and the nature of physicians' responses to these concerns during health supervision visits. The authors analyzed videotapes of child health supervision visits by 34 children aged 5-12 years to 34 pediatric and family medicine residents. Coding systems with acceptable interobserver reliability were developed to assess (1) the nature of opportunities provided to express concerns, (2) categories of psychosocial problems expressed by parents and children, and (3) the nature of physicians' responses. In 88% of the child health supervision visits, opportunities were created by the physician to discuss psychosocial concerns or were spontaneously raised by the parent or child. In half of the visits, parents or children expressed a total of 30 psychosocial concerns. Psychosocial problems raised included conduct/behavior problems (47%), insecurity (13%), family, sibling, or social problems (13%), learning difficulties (10%), somatization (7%), and other (10%). Physicians' responses to these psychosocial concerns were as follows: 17% ignored the concern; 43% asked further exploratory questions but provided no information, reassurance, or guidance; 3% reassured the parent; 27% responded with psychosocial information and/or action; 3% responded with medical information and/or action; and 7% responded with a combination of these latter two modes of actions. Pediatric residents were more likely to respond to more disruptive behavioral concerns (r = .60, P < .05). This study has documented that parents and children are given and take the opportunity to express psychosocial concerns to their physicians. Unfortunately, in only 40% of cases did physicians respond with information, reassurance, guidance, or referral. This study suggests the importance of further efforts focusing on the ability of physicians to respond effectively to patients' psychosocial concerns.
Key Words: psychosocial problems • child health supervision • resident education
Received for publication Mar 1, 1990; Accepted Jul 19, 1991.
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