Pediatric Behavioral Concerns : Does Physician Training Influence Their Referral and Recommendation Practices

Pediatric primary care physicians indicate behavioral health concerns to be the most frequently reported complaint of parents during well-child visits. Over the last few decades, graduate medical education and training requirements in the area of behavioral management have been expanded to better equip pediatric primary care physicians to appropriately address these issues in practice. Even so, physicians continue to report a lack of knowledge in addressing these issues. Many behavior management techniques, especially time-out, have been shown to be effective in reducing pediatric behavior concerns. While pediatric primary care physicians generally understand these techniques, it is difficult for them to adequately address behavior concerns due to the time constraints they face in practice. Behavior management techniques typically require a high level of individualization per case, and mental health professionals who have the training and time to appropriately address pediatric behavior concerns may be better suited to handle these types of cases. The goal of this study was to examine how pediatric training in the area of behavioral management influences appropriate referral and recommendation practices of 232 pediatric primary care physicians regarding behavioral concerns. Additionally, differences between pediatricians and family physicians in their referrals and recommendations were evaluated. Preexisting data from the circulation of the Pediatric Behavior Management Survey for Physicians (PBMSP) was used in this study. Correlational analyses indicated that pediatric primary care physicians have a greater likelihood to refer their patients with behavior concerns to a psychologist regardless of the type of training they obtained in the area of behavior management. Additionally, those who received specific training in time-out or received supervised training had a greater likelihood to refer to a behavior analyst or social worker than those who only received training in general discipline. A multiple regression analysis indicated that type of training does not appear to predict whether physicians will make appropriate referrals to outside professionals, r²= .047, F(4,227)= 2.821, p <.05. A logistical regression indicated that the type of training and appropriateness of referral significantly predicted whether or not a physician recommends time-out, X² (5, N=230) = 17.820, p<.01. Independent samples t-tests pediatricians (M = 5.734, SD =.189) were significantly more likely to refer patients to psychologists than were family physicians (M = 4.928, SD =.117), r²= .054, t(229)= -3.627, p = .0004. A chi-square test indicated that there is a difference between specialty and the recommendation of time-out, X² (1, N=230) = 6.301, p <.05, and that family physicians are less likely to recommend time-out than pediatricians, p < .01. Limitations of this study include small sample size, generalizability, and survey construction. The results from this study provide insight into whether the changes that have been made in pediatric education and whether the push for collaboration amongst professionals have been successfully integrated into pediatric practice