The Pediatric Symptom Checklist. Support for a role in a managed care environment
M. Jellinek, M. Little, J. M. Murphy and M. Pagano
Child Psychiatry Service, Massachusetts General Hospital, Boston, USA.
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.
Targeted child psychiatric services: a new model of pediatric primary clinician--child psychiatry collaborative care.
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