Behavioral and Mental Health Screening Practices, Barriers, and Facilitators: A National Survey of Pediatricians.
Academic Article
Overview
abstract
OBJECTIVE: Although early identification of behavioral and mental health (B/MH) conditions is important, integration of B/MH screening in pediatric practices may be challenging. This study reports factors associated with B/MH standardized screening and characterizes barriers and facilitators to screening identified by primary care and subspecialty pediatricians who reported that they did not use standardized screening tools. METHODS: This cross-sectional, mixed-methods study surveyed pediatricians who enrolled in the American Board of Pediatrics Maintenance of Certification program from January 01, 2023 to December 31, 2023. Demographic and practice characteristics associated with B/MH screening were identified using multivariable logistic regression. Descriptive statistics were used to summarize prespecified survey responses and qualitative content analysis was used to examine free-text responses describing barriers and facilitators. RESULTS: Of 5003 pediatricians who met the inclusion criteria, 1026 (20.5%) reported not screening for B/MH conditions using standardized tools. Subspecialists were significantly less likely to report screening than general pediatricians (odds ratio [OR] = 0.19, 95%CI:0.16-0.22). In adjusted analysis, older pediatricians (40-49 years: aOR = 1.25,95%CI:1.01-1.55; ≥50 years: aOR = 1.52, 95%CI:1.22-1.89) and those practicing in the West (aOR = 1.27, 95%CI:1.02-1.58) reported higher odds of screening, while pediatricians in urban areas (inner-city: aOR = 0.64, 95%CI:0.52-0.80; noninner city: aOR = 0.67,95%CI:0.54-0.82) and with academic appointments (aOR = 0.73, 95%CI:0.61-0.88) reported lower odds of screening. Among those not utilizing standardized screening tools, the most commonly reported barriers were lack of practice prioritization and perceived responsibility, while the most common facilitator was designated staff to conduct screening. CONCLUSIONS: Approximately 1-in-5 pediatricians reported that they did not perform standardized screening for B/MH conditions, describing several multilevel barriers which warrant targeted intervention.
