Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
Nursing, University of New Hampshire, Durham, NH, United States of America.
J Pediatr Nurs. 2021 Jul-Aug;59:37-44. doi: 10.1016/j.pedn.2020.12.014. Epub 2021 Jan 15.
To provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks.
Participants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview.
Almost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health.
Findings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks.
Protocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.
提供来自美国各地儿科和家庭医学初级保健提供者的大量样本信息，了解他们在筛查儿童行为健康风险方面的实践情况。
参与者是来自美国各地的医生（n=319）和护士从业者（n=292），他们通过计算机辅助的自我访谈完成了一项关于筛查实践的机密在线调查。
几乎所有的受访者（89%）都报告了对儿童的抑郁/焦虑和行为问题进行筛查。儿童物质使用（82%）、家庭社会支持（74%）、重大家庭变化（73%）、欺凌（72%）、儿童虐待（62%）和家庭暴力（52%）也经常被问到，尽管使用了非正式的筛查方法。对照顾者的心理健康（49%）、照顾者的物质使用（35%）、家庭经济压力（33%）和交通困难（27%）的筛查频率较低。筛查与更高的风险相关问题转诊率相关，当提供者报告对为客户提供支持更有信心、认为社区资源可用性更高、并且在具有综合初级保健和行为健康的系统中工作时，筛查的可能性更大。
研究结果表明，提供者在筛查行为健康风险方面存在很大的差异。当解决问题的选择被认为有限时，人们不愿意进行筛查。需要开展研究，以便更好地指导医疗保健提供者确定筛查社会风险的正确背景和方法。
筛查不良儿童事件（ACES）和其他社会风险因素的方案应辅以充分的培训，并努力改善社区资源和支持网络。
