Increasing Parent-Pediatrician Communication about Children's Psychosocial Problems

Objective To examine the differential effects of two scoring procedures for a parent-completed measure, the Pediatric Symptom Checklist (PSC), designed to assess children's behavioral and emotional functioning, on parent-pediatrician communication concerning psychosocial issues. Methods Prior to their medical appointment, 174 parents of children aged 4-16 were assigned to one of three experimental conditions: (1) typical medical care control, (2) Staff-Scored PSC administration, or (3) Parent-Scored PSC administration. Following the appointment, parent perception of parent-pediatrician communication was assessed. Results For children with more emotional and behavioral problems, participants in the Parent-Scored group and the Staff-Scored group had better parent-pediatrician communication scores than those in the control group. Conclusions Both the Staff-Scored and Parent-Scored administrations of the PSC improved parentpediatrician communication on psychosocial issues. The Parent-Scored PSC removed the scoring burden on the medical personnel. Key words emotional and behavioral functioning; parent-physician communication; pediatric psychosocial screening; psychosocial problem detection. Pediatricians are a near-ideal group for detecting psychosocial problems in children and adolescents and for discussing these issues with families. Pediatricians follow children over time, developing rapport with the family as they make developmental and health recommendations. Despite guidelines developed by the American Academy of Pediatrics (AAP) for increasing pediatricians' attention to psychosocial problems (American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health, 2001), there continues to be a deficit in pediatricians' communication with parents about children's behavioral and emotional problems. Past studies have reported pediatrician detection rates of psychosocial problems (e.g., behavioral, developmental, and social problems) in children visiting pediatricians ranging from as low as 17-50% Multiple barriers exist that limit pediatricians' communication about children's psychosocial issues. For example, there is a perception that discussing their patients' psychosocial functioning will significantly prolong the length of the visit, despite mixed findings on how the discussion of the issues may impact appointment length In addition to pediatrician barriers, parents may be reluctant to disclose their concerns to pediatricians (Briggs-Gowan, Horwitz, Schwab-Stone, To address these barriers, pediatricians and/or parents have participated in training programs designed to improve communication. However, these interventions tend to be time intensive and costly with benefits often failing to maintain Despite their usefulness and feasibility, standardized screening tools such as the PSC are not being adopted by practitioners in medical settings The purpose of the current study was to extend the evaluation of the PSC to examine its effectiveness for increasing parent-pediatrician communication about children's psychosocial issues in pediatric healthcare settings, as compared to a typical medical care condition. Given the reticence of pediatricians to adopt use of the PSC because of perceived administrative burden, an alternate scoring procedure was introduced in addition to the standard approach. In previous studies, standard administration of the PSC consisted of medical personnel distributing the inventory, collecting it from the parent, and placing it in the child's medical record to be scored, reviewed, and interpreted by the pediatrician. Collection and scoring of the PSC are time-consuming activities that do not require training or special qualifications. The Parent-Scored PSC developed for this study was designed to decrease the administrative burden on the medical facility and increase parent involvement in care. The Parent-Scored PSC involved the following changes: (1) parents were provided with clear, simple scoring instructions and scored their own PSC questionnaire; (2) parents were instructed to maintain possession of the questionnaire and to hand the scored questionnaire directly to the pediatrician during their meeting; and (3) following completion and scoring of the PSC, parents were given interpretation information indicating the range of scores considered to be clinically significant. Providing the interpretation information following completion and scoring of the PSC was intended to insure that parents did not over-or underpathologize their children's behavior based on their knowledge of how to interpret the measure. Parents were also told they could initiate discussion about behaviors on the PSC regardless of the total score, thus taking a dimensional as opposed to a categorical approach to assessment of their children's psychosocial issues. In this investigation, children were divided into those whose PSC scores were high, indicating more emotional and behavioral problems, and those whose scores reflected lower levels of child behavioral difficulties. For children who received high scores on the PSC, it was expected that parents in the two PSC intervention groups would engage in significantly more communication with the pediatricians about their children's psychosocial functioning when compared with those in the typical medical care control group. Similarly, for items endorsed as occurring ''often'' on the PSC, it was hypothesized that parents in the two PSC intervention groups would engage in more communication with their pediatrician about those items than the parents in the control group. No differences in parent-pediatrician communication were expected for parents of children with lower PSC scores since those children with few or minor psychosocial problems would require little if any parent-pediatrician communication about the topic. Pediatricians in the Staff-Scored PSC group and parents in the Parent-Scored PSC group were expected to be the ones who initiated more communication about psychosocial issues. Finally, it was expected 1156 Hayutin, Reed-Knight, Blount, Lewis, and McCormick that parents of children who received high scores, indicating that more issues were in need of discussion, would feel that psychosocial issues were discussed ''enough'' in both PSC groups relative to parents in the standard medical care group. Methods Participants Two hundred and eighty-nine parents of children aged 4-16 attending a medical appointment with a pediatrician in one of two medical clinics in the southeastern United States were approached for participation. Of those, 35 (12%) refused participation because they lacked the time and 25 (8.65%) were not interested. Data were collected in physicians' waiting rooms before and after the child's appointment. Fifty-seven enrollees (19.7%) completed the PSC prior to their appointment but left the office prior to completing the Communication Questionnaire following their appointment. These participants were excluded from the analyses due to incomplete data. The final sample included 172 parents of children attending medical appointments, of which 89 attended a primary care group practice and 83 attended a pediatric gastroenterological practice. Patients seen at the primary care group practice were seen for the following reasons: 56% follow-up/check-up, 12% ear, nose, and throat problems, 6% gastrointestinal problems, 4% dermatological problems, 2% injury, and 19% other/unknown. Patients seen at the pediatric gastrointestinal practice were seen for the following reasons: 27% stomach pain, 20% follow-up/check-up, 13% reflux, 12% constipation, 5% vomiting, and 23% other/unknown. These two settings were selected to increase external validity and speak to the generalizability of the findings. Furthermore, pediatric gastroenterology in particular was chosen due to its being one of the more highly utilized subspecialty services Measures Background information. Parents provided information about the child's age and race, their gender, income, and marital status and reasons for the visit and length of time the child had been the treating physician's patient. Child psychosocial adjustment. Two scoring methods for the 35-item PSC were used