Implementation Research posted on January 27, 2010 09:52 Katherine E. Murray, Andrew J. Barnes, Marjorie Ireland, Daniel P. Kohen.. Pediatrics, University of Minnesota, Minneapolis, MN. BACKGROUND: Primary care clinicians are increasingly called upon to diagnose and treat emotional/behavioral disorders in children. Nevertheless, prior studies have shown these disorders often go undetected. Our study examines how physicians screen for emotional/behavioral problems in everyday clinical practice. OBJECTIVE: To assess the specific techniques and instruments primary care pediatricians and family practitioners use to detect emotional and behavioral problems, to describe beliefs about the prevalence of these problems, and barriers to universal screening. DESIGN/METHODS: Cross-sectional study employing a survey mailed to 1567 family practitioners and pediatricians in the Minneapolis-St. Paul metro area (n=268 eligible participants). RESULTS: Primary care physicians perceive emotional/behavioral problems as highly prevalent in children and adolescents. Nearly 80% of physicians screened during all well child visits across age groups. Traditional techniques were most commonly used, as over 90% of respondents endorsed non-standardized interviewing, review of systems, and/or clinical observation; 20% endorsed any use of a standardized, validated tool for broad developmental screening. However, consistent and universal use of such tools was endorsed by only 2.6%. Standardized screening tools targeting emotional/behavioral problems were used less often, with 11% doing so at least some of the time; virtually no respondents did so universally and consistently. Screening of any type was more likely to occur during well child care than during acute visits. Standardized screening rates did not differ based on age, gender, or specialty. The standardized emotional/behavioral screening tools used most frequently were the PEDS and the PSC. Barriers to such screening included lack of time (93%), lack of training (88%), lack of mental health providers (79%), and lack of adequate personnel (77%). CONCLUSIONS: Primary care physicians concur with existing data regarding the prevalence of emotional/behavioral problems and this is associated with screening using predominantly non-standarized techniques. Low detection rates for emotional/behavioral problems may be improved by universal standardized screening. Removing or ameliorating barriers will be an important part of implementing any universal screening program. Note from Frances Glascoe (PEDS author): This study really speaks to the need for quality improvement studies in which providers can study their referral rates when using informal approaches and ccompare these to referral rates found by standardized measures. And, it would also be helpful to measure the amount of time clinicians spend in informal measurement (e.g., trying to elicit parents' concerns and children's milestones) to the seeming time-saves of getting that information ahead of the actual encounter. Providers probably spend more time than they think-time that would be better spent, once PEDS:DM/PEDS are deployed, in educating families and facilitating referrals. Given studies like Dr. Shonwald's (above), there are clearly dispel the misperceptions that using quality measures takes more time. My hypothesis is that they may save time.