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Support for a Role in a Managed Care Environment

Michael Jellinek, MD; Michelle Little; J. Michael Murphy, EdD; Maria Pagano, EdM

Arch Pediatr Adolesc Med. 1995;149(7):740-746.

Abstract
Objectives
To gather data based on studies of the Pediatric Symptom Checklist, identify risk factors associated with high levels of dysfunction in primary care pediatric settings, and explore the relationship between common risk factors and psychosocial problems identified by pediatricians.

Design
Retrospective review and cross-sectional, case-referent survey.

Setting
Subjects were selected from three primary care pediatric clinics in Massachusetts: a private practice in a predominantly white, middle-class suburb, an urban health maintenance organization clinic, and an inner-city clinic.

Participants
Of 423 outpatients aged 6 to 12 years screened for psychosocial problems, 72 children and their families were seen for in-depth structured and clinical interviews (24 from each site).

Interventions
None.

Measurements/Main Results
Children with a single parent and/or those who were economically disadvantaged were significantly more likely to show psychosocial impairment. The specificity of the Pediatric Symptom Checklist was 100% in samples with a lower socioeconomic status compared with 68% in middle-class samples, and sensitivity was 95% in middle-class samples compared with 80% in lower-class samples. Pediatricians identified psychosocial problems in eight of 15 children with a history of familial mental illness or substance abuse and seven of eight children with a history of physical or sexual abuse, but only six of 17 cases from single-parent families and four of 11 cases from poor families.

Conclusions
Pediatricians should be sensitive to psychosocial dysfunction especially in single-parent and low-income families. Use of the Pediatric Symptom Checklist for psychosocial screening in a managed health care delivery system could target capitated resources efficiently by providing early identification and secondary prevention of psychosocial morbidity.

(Arch Pediatr Adolesc Med. 1995;149:740-746)

Author Affiliations
From the Child Psychiatry Service, Massachusetts General Hospital, Boston.

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