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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 129-133

Brief Psychosocial Screening at Health Supervision and Acute Care Visits

Iris Wagman Borowsky, MD, PhD, Sara Mozayeny, BA and Marjorie Ireland, PhD

From the Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota


   ABSTRACT
TOP
 ABSTRACT
METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Objective. To identify factors associated with positive scores on a brief psychosocial screening tool with subscales for internalizing, externalizing, and attention problems.

Methods. Parents of 2028 children between the ages of 7 and 15 years seen in a sample of 8 primary care practices in the Minneapolis-St Paul metropolitan area completed a brief questionnaire that included the 17-item Pediatric Symptom Checklist (PSC), demographic information, and the reason for the child’s visit to the clinic.

Results. Overall, 22% of the youth had at least 1 positive PSC-17 subscale or a positive PSC-17 total score. Twelve percent scored positive on the internalizing subscale, 10% on the externalizing subscale, 7% on the attention subscale, and 11% had a positive PSC-17 total score. Although boys were more likely than girls to score positive on the attention and aggression subscales, boys and girls were equally likely to have a positive score on the depression subscale. Children not living with both biological parents and those with a household member receiving public assistance were significantly more likely to show psychosocial dysfunction. Controlling for demographic characteristics, patients presenting for an illness-related or injury visit were more likely to score positive on the screen than those presenting for a routine well-child visit (odds ratio: 1.46; 95% confidence interval: 1.07–1.98).

Conclusions. Clinicians will miss opportunities to identify emotional and behavioral disorders among children and adolescents who may be at a higher risk if they limit psychosocial screening to health supervision visits. Further research is needed to identify effective strategies for using primary care for recognizing, diagnosing, and treating mental health disorders in children and adolescents.

Key Words: psychosocial screening • primary care • pediatrics • mental health

Abbreviations: PSC, Pediatric Symptom Checklist

The underdetection of child mental health problems in pediatric practice has been well-documented.1,2 Studies have found rates of psychosocial disorders as high as 27% among 4- to 16-year-olds and 13% among preschool children.3,4 Unfortunately, pediatricians identify only a small portion of these children, and few use standardized methods for identification of emotional or behavioral problems. Costello and Shugart5 reported that pediatricians identified only 15% of their school-age patients with significant behavioral or emotional disorders. Likewise, Lavigne et al4 found that pediatricians identified only 21% of emotional and behavioral problems in preschoolers when asked about the presence or absence of these problems, as compared with the Child Behavior Checklist and confirmation by a child psychologist. Because most children with psychosocial dysfunction are seen in general medical rather than mental health settings, many children who might benefit from mental health treatment, including counseling, medication, and specialist referrals, do not receive these services.6,7 Untreated emotional and behavioral disorders, including depression and antisocial behavior problems, contribute to poor overall functioning; school failure; and adolescent and adult crime, violence, substance abuse, and suicide.8–10

The Pediatric Symptom Checklist (PSC) was developed to facilitate recognition and referral of child psychosocial problems by primary care pediatricians.11,12 The PSC is a 35-item, parent-completed screening questionnaire of children’s emotional and behavioral problems. The feasibility of using the PSC to screen for psychosocial problems has been demonstrated in pediatric and family medicine practices nationwide.13 The PSC has strong internal consistency, test-retest reliability, and validity with psychiatric assessments of child functioning.11,12 The instrument’s validity and reliability have been demonstrated in a variety of populations, including minority and low-income youth.14,15 One study also demonstrated the validity of a shortened version of the PSC, the PSC-17, consisting of subscales for internalizing, externalizing, and attentional symptoms.16 The reduction in items simplifies use of the instrument in clinical settings, and the subscale scores can serve as a guide for clinicians in assessing and managing the child.

Screening for emotional and behavioral problems has been recommended as a routine part of health supervision visits.17–20 From ages 6 to 10, health supervision visits are routinely advised every 2 years, with annual visits recommended for adolescents beginning at age 11.17–19 However, national surveys indicate that 33% to 44% of adolescents report that they have not had a check-up or routine physical examination in the past year.21,22 Of the ~62 million visits to physicians each year by adolescents aged 11 to 21 years in the United States, only ~22% are health supervision visits.23 Thus, screening youth in middle childhood and adolescence for psychosocial dysfunction at health supervision visits is only likely to miss a substantial percentage of youth who could be reached at acute care visits. For the present study, youth presenting to clinic for any type of medical visit were screened with the PSC-17. The purpose of the study was to describe characteristics of youth who score positive on the PSC-17. Specifically, it was hypothesized that youth presenting for a non-routine visit would be more likely to have a positive score on the PSC-17 than those presenting for a health supervision visit.


   METHODS
TOP
 ABSTRACT
 METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
The study was conducted at 8 out-patient pediatric practices in the Minneapolis-St Paul metropolitan area. The practices included 2 urban community clinics, 2 urban private practices, and 4 suburban private practices. During defined data collection periods, all consecutive English-speaking parents of children aged 7 to 15 seen for a medical visit were invited to complete the PSC-17 before their visit with the primary care clinician. Research assistants explained the purposes and procedures of the study to the parents. Participation was voluntary. Procedures and consent forms were approved by the Institutional Review Board of the University of Minnesota. Parents also provided demographic information and the reason for their child’s visit to the clinic.

The PSC-17 consists of 17 symptoms that parents rate as "often," "sometimes," or "never" present in their child. The PSC-17 is scored by assigning 2, 1, or 0 points, respectively, to these ratings. The points are then added to obtain PSC-17 subscale and total scores. The internalizing subscale consists of 5 items: "feels sad, unhappy," "feels hopeless," "is down on self," "worries a lot," "seems to be having less fun"; the externalizing subscale consists of 7 items: "fights with other children," "does not listen to rules," "does not understand other people’s feelings," "teases others," "blames others for his/her troubles," "refuses to share," "takes things that do not belong to him/her"; the attention subscale consists of 5 items: "fidgety, unable to sit," "daydreams too much," "distracted easily," "has trouble concentrating," "acts as if driven by a motor." A positive score for each of the subscales was as follows: 5 or greater for the internalizing subscale, 7 or greater for the externalizing subscale, and 7 or greater for the attention subscale. A positive score on the screen was defined as at least 1 positive PSC-17 subscale or a PSC-17 total score of ≥15.16

The data were initially examined using bivariate descriptive statistics. We used c2 tests to examine the significance of differences in having a positive or negative score on the screen when data were stratified by other factors, such as patient gender, age, race/ethnicity, family structure, welfare status, and visit type. To assess the overall effect of visit type on scoring positive on the screen after controlling for potential confounding factors listed above, we used a generalized linear models procedure based on generalized estimating equations, PROC GENMOD, which allowed us to control for clustering of participants by pediatric practices. Because the dependent variable was dichotomous, we specified the binomial distribution for the dependent variable in the PROC GENMOD code.


   RESULTS
TOP
 ABSTRACT
 METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Ninety-one percent of the 2315 parents who were approached agreed to complete the questionnaire. Overall, 22% of youth (451/2028) scored positive on the screen. As shown in Table 1, 250 (12%) of the youth scored positive on the internalizing subscale, 202 (10%) scored positive on the externalizing subscale, and 144 (7%) scored positive on the attention subscale. Nearly half of the 22% of youth scoring positive on the screen (224/451) had a positive PSC-17 total score. Of the 451 youth with a positive score, 307 (68%) had 1 positive subscale, 107 (24%) had 2 positive subscales, and 25 (6%) had 3 positive subscales. The remaining 12 patients (3%) scoring positive had a positive PSC-17 total score, but did not score positive on any of the subscales. Cronbach {alpha} coefficient, a measure of the internal consistency of a multi-item scale, ranged from 0.67 to 0.82 for the PSC-17 and its subscales (Table 1).


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  		TABLE 1. Percentage of Youth Scoring Positive and Internal Consistency Measure on the PSC-17 Subscales

 
Demographic and visit-related characteristics of the sample are presented in Table 2. Most screens were completed by the child’s mother. Routine well-care characterized the reason for 46% of visits. The remainder presented for a non-routine visit, such as for illness, follow-up on illness, or injury.


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  		TABLE 2. Characteristics of Youth and Families

 
Youth with a positive score on the screen were significantly more likely than youth with a negative score to be male, non-white, not living with both biological parents, and receiving welfare (Table 2). Visit type also differed between those scoring positive and negative on the screen, with youth scoring positive more likely to be presenting to clinic for a non-routine visit than those scoring negative (61% vs 52%, P < .001). Likewise, for each of the subscales and the PSC-17 total, a greater percentage of youth who scored positive presented to clinic for a non-routine visit than those who scored negative. This difference was statistically significant for the PSC-17 total only (63% vs 54%, P = .02) and approached significance for the internalizing subscale (61% vs 54%, P = .07). Although boys were more likely than girls to score positive on the attention subscale (10% vs 4%, P < .001), the aggression subscale (12% vs 9%, P = .025), and the PSC-17 total (13% vs 9%, P = .001), boys and girls were equally likely to have a positive score on the depression subscale (12% of both boys and girls).

We used multivariate analysis to assess the importance of visit type on having a positive score on the screen while controlling for possible confounders (Table 3). After adjusting for patient gender, age, race/ethnicity, family structure, and welfare status, patients presenting for an illness-related or injury visit were more likely to score positive on the screen than those presenting for a routine visit (odds ratio: 1.46; 95% confidence interval: 1.07–1.98).


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  		TABLE 3. Odds Ratios for Scoring Positive on the PSC-17

 

   DISCUSSION
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
First proposed by Haggerty et al24 in 1975 as the "new morbidity," psychosocial problems have become the most common chronic condition for pediatric visits.25 In this sample of youth ages 7 to 15, 12% scored positive on the internalizing subscale, 10% on the externalizing subscale, and 7% on the attention subscale. Overall, 11% had a positive PSC-17 total score, and 22% had at least one positive PSC-17 subscale score or a positive total score. These rates are comparable to those found in other studies using parent-completed measures including the PSC-1716 and the Diagnostic Interview Schedule for Children.26 However, these studies observed a higher rate of externalizing symptoms than internalizing symptoms among the samples of youth studied, whereas more youth scored positive on the internalizing than the externalizing subscale in our study. Other findings that are consistent with previous work include the higher rate of psychosocial problems seen in boys, youth who are not living with both biological parents, and those with a household member receiving public assistance.13,27 The current study was the first to demonstrate an increased risk of psychosocial dysfunction for youth presenting to clinic for a sick visit as compared with those presenting for a health supervision visit.

It should be noted that a positive score on the PSC-17 is not a diagnosis, but rather an indication for further assessment of the child and family, with subscale scores serving as a guide for the assessment.16 Although the PSC-17 subscales show good agreement with previously validated parent-report instruments of internalizing, externalizing, and attention problems, they have not yet been validated with confirmatory diagnoses.16 Case classifications on the 35-item PSC, from which the PSC-17 is derived, have shown good agreement with case classifications on the Children’s Behavior Checklist, clinicians’ Global Assessment Scale ratings of impairment, and the presence of psychiatric disorder in a variety of pediatric and subspecialty settings representing diverse socioeconomic backgrounds.11,12,14,15,28,29

The greater likelihood of scoring positive on the PSC-17 among patients presenting for a sick visit as compared with those presenting for a health supervision visit may be associated with acute care visits for symptoms related to emotional and behavioral problems. Campo et al30 found that children and adolescents with frequent complaints of pain were significantly more likely than unaffected children to show signs of an emotional or behavioral problem based on the PSC-17 subscales and clinician impression. Recurrent pain was also significantly associated with greater health service use and visits to the doctor for medically unexplained symptoms.

Attention to psychosocial and behavioral problems has long been recommended as a critical component of well-child care.20,24 Guidelines for incorporating screening and assessment of emotional and social development and behavior into health supervision have been published.17–19 Given the high rates of unrecognized, untreated psychosocial problems in children and adolescents, using every contact with a family, including acute care visits, as an opportunity to screen for psychosocial problems, will likely increase detection of children with emotional and/or behavioral disorders. This strategy has been used successfully to increase immunization rates among children.31–34 Although immunizations are an essential part of health supervision, acute care visits provide an opportunity to review the child’s or adolescent’s immunization status, emphasize the importance of being appropriately immunized, and encourage catch-up immunization at a current or follow-up visit. Evidence suggests that immunization levels can be improved by up to 30% by eliminating missed opportunities for vaccination.31,34 Similarly, screening for psychosocial problems at any visit, whether for an acute illness or well care, if not done within the past 6 to 12 months, will increase the chances that annual screening is achieved and take advantage of opportunities to identify problems that would otherwise be missed. In addition, use of a brief psychosocial screen can help limit inefficient use of professional time, guiding pediatricians on which patients to pursue psychological questioning.27

Use of the PSC in pediatric settings has been shown to significantly increase rates of mental health referrals.15,35 Furthermore, there is evidence that psychosocial screening followed by referral to mental health services for youth identified with psychosocial dysfunction results in improved outcomes.36 Recognition and appropriate management of emotional and behavioral problems in children has been identified as one of the best ways to prevent delinquency, violence, and other high-risk behaviors.20,37 Effective or promising treatments for many mental disorders exist in children, including cognitive-behavioral therapy and selective serotonin reuptake inhibitors for depression,38,39 parent training and multisystemic therapy for conduct disorder,40 and psychostimulants and behavioral training of teachers for attention-deficit/hyperactivity disorder.41,42 Improving the diagnosis and treatment of mental health problems among children and adolescents in primary care settings requires addressing important environmental, physician, and patient factors such as: attitudinal and procedural barriers to implementing and sustaining a clinic system for psychosocial screening with the PSC-17 or other tool35,43; inadequate provider knowledge about mental and behavioral issues and mental health treatment resources in the community; insufficient reimbursement to primary care providers for their efforts in identifying, referring, and treating children with mental health disorders; short supply of mental health services and providers for children and adolescents; fragmented mental health service systems; financial barriers to accessing mental health treatment; and the stigma surrounding mental illness.44 Pediatrician training about emotional and behavioral issues, primary care-friendly guides to assessment and diagnosis of psychosocial problems, and strengthening collaborative relationships between pediatricians and mental health professionals will likely improve mental health services in primary care.25,26,45,46 The evaluation of screening and intervention for mental health problems on outcomes for youth will advance knowledge of effective evidence-based practice in primary care settings. A recent study demonstrated the dearth of research attention and federal funding for understanding the identification and treatment of children’s behavioral and emotional issues within primary medical care settings, despite considerable attention to this issue in the planning documents of many federal agencies.47 Given the magnitude and consequences of emotional and behavioral problems in children and adolescents coupled with the feasibility of screening and the potential for effective intervention, recognition of psychosocial problems is an important issue in primary care pediatric practice.


   ACKNOWLEDGMENTS
 
This study was supported by a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Award.

We thank Tiffany Austad, Becky Beucher, Jamie Blum, Jessica Boyer, Sarah Brand, Bridgett Erlanson, Rachel Friedlieb, Tony Nadler, Sandra Olsen, and Sopheak Srun for their efforts in collecting the study data. We also express deep appreciation to the patients, clinicians, and office staff at Central Pediatrics-Midway, St Paul, Minnesota, Community University Health Care Center, Minneapolis, Minnesota, Fairview Oxboro Clinic, Bloomington, Minnesota, Fairview Ridges Clinic, Burnsville, Minnesota, North End Medical Center, St Paul, Minnesota, Partners in Pediatrics-Robinsdale, Robbinsdale, Minnesota, Southdale Pediatric Associates-Burnsville, Burnsville, Minnesota, and Staub Pediatric Clinic, Minneapolis, Minnesota, for their participation in the study.


   FOOTNOTES
 
Received for publication Oct 3, 2002; Accepted Feb 21, 2003.

Address correspondence to Iris Wagman Borowsky, MD, PhD, Division of General Pediatrics and Adolescent Health, University of Minnesota Gateway, 200 Oak St, SE, Suite 160, Minneapolis, MN 55455. E-mail: borow004{at}tc.umn.edu


   REFERENCES
TOP
 ABSTRACT
 METHODS
 RESULTS
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 REFERENCES
 

  1. Costello EJ. Primary care pediatrics and child psychopathology: a review of diagnosis, treatment, and referral practices. Pediatrics.1986; 78 :1044 –1051[Abstract/Free Full Text]
  2. Costello EJ, Edelbrock C, Costello AJ. Psychopathology in pediatric primary care: the new hidden morbidity. Pediatrics.1988; 82 :415 –424[Abstract/Free Full Text]
  3. Horwitz S, Leaf P, Leventhal J, Forsyth B, Speechley K. Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics.1992; 89 :480 –485[Abstract/Free Full Text]
  4. Lavigne J, Binns H, Christoffel K, et al. Behavioral and emotional problems among preschool children in pediatric primary care: prevalence and pediatricians’ recognition. Pediatrics.1993; 91 :649 –655[Abstract/Free Full Text]
  5. Costello EJ, Shugart MA. Above and below the threshold: severity of psychiatric symptoms and functional impairment in a pediatric sample. Pediatrics.1992; 90 :59 –68
  6. Burns J, Costello J, Angold A, et al. Children’s mental health service use across service sectors. Health Aff.1995; 14 :147 –159[Abstract]
  7. Burns B, Costello E, Erkanli A, Tweed D, Farmer E, Angold A. Insurance coverage and mental health service use by adolescent with serious emotional disturbance. J Child Family Studies.1997; 6 :89 –111
  8. Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA.1989; 262 :914 –919[Abstract]
  9. Farrington DP. Childhood aggression and adult violence: early precursors and later-life outcomes. In: Pepler DJ, Rubin KH, eds. The Development and Treatment of Childhood Agression. Hillsdale, NJ: Lawrence Erlbaum Associates; 1991:5–29
  10. Farrington DP. Childhood origins of teenage antisocial behavior and adult social dysfunction. J R Soc Med.1993; 86 :13 –17[Abstract]
  11. Jellinek MS, Murphy JM, Burns B. Brief psychosocial screening in outpatient pediatric practice. J Pediatr.1986; 109 :371 –378[CrossRef][ISI][Medline]
  12. Jellinek MS, Murphy JM, Robinson J, Feins A, Lamb S, Fenton T. Pediatric Symptom Checklist: screening school-age children for psychosocial dysfunction. J Pediatr.1988; 112 :201 –209[CrossRef][ISI][Medline]
  13. Jellinek MS, Murphy JM, Little M, Pagano ME, Comer DM, Kelleher KJ. Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: a national feasibility study. Arch Pediatr Adolesc Med.1999; 153 :254 –260[Abstract/Free Full Text]
  14. Murphy M, Reede J, Jellinek MS, Bishop SJ. Screening for psychosocial dysfunction in inner-city children: further validation of the Pediatric Symptom Checklist. J Am Acad Child Adolesc Psychiatry.1992; 31 :1105 –1111[ISI][Medline]
  15. Murphy JM, Ichinose C, Hicks RC, et al. Utility of the Pediatric Symptom Checklist as a psychosocial screen to meet the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) standards: a pilot study. J Pediatr.1996; 129 :864 –869[CrossRef][ISI][Medline]
  16. Gardner W, Murphy M, Childs G, et al. The PSC-17: a brief pediatric symptom checklist including psychosocial problem subscales: a report from PROS and ASPN. Ambulatory Child Health.1999; 5 :225 –236
  17. Elster A, Kuznets N. AMA Guidelines for Adolescent Preventive Services (GAPS: Recommendations and Rationale). Baltimore, MD: Williams & Wilkins; 1994
  18. Green M, ed. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. Arlington, VA: National Center for Education in Maternal and Child Health; 1994
  19. Stein MT, Wolraich ML, eds. Guidelines for Health Supervision III. Elk Grove Village, IL: American Academy of Pediatrics; 1997
  20. Hawkins-Walsh E. Turning primary care providers attention to child behavior: a review of the literature. J Pediatr Health Care.2001; 15 :115 –122[Medline]
  21. Ford CA, Bearman PS, Moody J. Forgone health care among adolescents. JAMA.1999; 282 :2227 –2234[Abstract/Free Full Text]
  22. National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. 2001 Youth Risk Behavior Survey Results. Available at: http://www.cdc.gov/nccdphp/dash/yrbs/data/2001/codebook.html. Accessed September 9, 2002
  23. Brindis C, Park J, Ozer EM, Irwin CE. Adolescents’ access to health services and clinical preventive health care: crossing the great divide. Pediatr Ann.2002; 31 :575 –581[ISI][Medline]
  24. Haggerty R, Roghmann KJ, Pless IB. Child Health and the Community. New York, NY: John Wiley & Sons; 1975
  25. Kelleher KJ, McInerny TK, Gardner W, Childs GE, Wasserman R. Increasing identification of psychosocial problems: 1979–1996. Pediatrics.2000; 105 :1313 –1321[Abstract/Free Full Text]
  26. Briggs-Gowan M, Horwitz S, McCue S, Schwab-Stone ME, Leventhal JM, Leaf PJ. Mental health in pediatric settings: distribution of disorders and factors related to service use. J Am Acad Child Adolesc Psychiatry.2000; 39 :841 –849[CrossRef][ISI][Medline]
  27. Jellinek M, Little M, Murphy J, Pagano M. The Pediatric Symptom Checklist: support for a role in a managed care environment. Arch Pediatr Adolesc Med.1995; 149 :740 –746[Abstract]
  28. Jellinek MS, Bishop SJ, Murphy JM, Biederman J, Rosenbaum JF. Screening for dysfunction in the children of outpatients at a psychopharmacology clinic. Am J Psychiatry.1991; 148 :1031 –1036[Abstract/Free Full Text]
  29. Rauch PK, Jellinek MS, Murphy JM, et al. Screening for psychosocial dysfunction in pediatric dermatology practice. Clin Pediatr.1991; 30 :493 –497
  30. Campo JV, Comer DM, Jansen-McWilliams L, Gardner W, Kelleher KJ. Recurrent pain, emotional distress, and health service use in children. J Pediatr.2002; 141 :76 –83[CrossRef][ISI][Medline]
  31. Carlin E, Carlson R, Nordin J. Using continuous quality improvement tools to improve pediatric immunization rates. Jt Comm J Qual Improv.1996; 22 :277 –288[Medline]
  32. Ball TM, Serwint JR. Missed opportunities for vaccination and the delivery of preventive care. Arch Pediatr Adolesc Med.1996; 150 :858 –861[Abstract]
  33. Rudner N. Potentials for improving health department immunization rates: the relationships between service delivery factors and immunization completion. J Public Health Manage Prac.1996; 2 :50 –58
  34. Szilagyi PG, Rodewald LE. Missed opportunities for immunizations: a review of the evidence. J Public Health Manage Prac.1996; 2 :18 –25[Medline]
  35. Murphy JM, Arnett HA, Jellinek MS, Bishop SJ, Reede J. Screening for psychosocial dysfunction in pediatric practice: a naturalistic study of the Pediatric Symptom Checklist. Clin Pediatr.1992; 31 :660 –666
  36. Gall G, Pagano ME, Dessmond MS, Perrin JM, Murphy JM. Utility of psychosocial screening at a school-based health center. J School Health.2000; 70 :292 –297[ISI][Medline]
  37. Rivara FP, Farrington DP. Prevention of violence: role of the pediatrician. Arch Pediatr Adolesc Med.1995; 149 :421 –429[Abstract]
  38. Emslie GJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody TJ, Rush AJ. Fluoxetine treatment of depressed children and adolescents. Arch Gen Psychiatry.1997; 54 :1031 –1037[Abstract]
  39. Kaslow NJ, Thompson MP. Applying the criteria for empirically supported treatments to studies of psychosocial interventions for child and adolescent depression. J Clin Child Psychol.1998; 27 :146 –155[CrossRef][ISI][Medline]
  40. Brestan EV, Eyberg SM. Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. J Clin Child Psychol.1998; 27 :180 –189[CrossRef][ISI][Medline]
  41. Greenhill L, Abikoff H, Arnold L, et al. Psychopharmacological Treatment Manual, NIMH Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA Study). New York, NY: Psychopharmacology Subcommittee of the MTA Steering Committee; 1998
  42. Pelham WE Jr, Wheeler T, Chronis A. Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. J Clin Child Psychol.1998; 27 :190 –205[CrossRef][ISI][Medline]
  43. Cheng TL, Perrin EC, DeWitt TG, O’Connor KG. Use of checklists in pediatric practice. Arch Pediatr Adolesc Med.1996; 150 :768 –769[ISI][Medline]
  44. US Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health; 1999
  45. Pincus HA. Linking general health and mental health systems of care: conceptual models of implementation. Am J Psychiatry.1980; 137 :315 –320[Abstract/Free Full Text]
  46. Kelleher KJ, Wolraich ML. Diagnosing psychosocial problems. Pediatrics.1996; 97 :899 –901[Abstract/Free Full Text]
  47. Horwitz SM, Kelleher K, Boyce T, et al. Barriers to health care research for children and youth with psychosocial problems. JAMA.2002; 288 :1508 –1512[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics



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