Talk training helps providers improve families’ mental health

Last Updated: 2008-02-19 15:03:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) – A brief program that teaches primary care providers how to elicit and address parent and child mental health concerns has shown promise in a cluster-randomized trial conducted at 13 pediatric and family care practices in rural New York, urban Maryland and Washington, DC.

"Brief primary care provider training reduced mental health symptoms among parents of children with emotional and behavioral disturbances and led to reduction in impairment among minority children," Dr. Lawrence Sagin Wissow from Johns Hopkins School of Pubic Health, Baltimore and colleagues report in the February issue of Pediatrics.

This study "validates the idea that primary care providers (doctors, nurse practitioners, PAs) can have an impact on mental health problems," Dr. Wissow added in an e-mail to Reuters Health.

Fifty-eight providers (31 trained and 27 controls), 418 multiethnic children (248 patients of trained providers and 170 treated by control providers) with "possible" or "probable" mental health disorders, and 418 parents participated in the study. The providers were taught communication skills targeted at "eliciting parent and child concerns, partnering with families, and increasing expectations that treatment would be helpful," the investigators explain.

The training was conducted in three sessions spaced 3 weeks apart. Sessions consisted of a 60-minute, small-group discussion led by a child psychiatrist, followed by a 10-minute, standardized patient visit, which was videotaped.

After the 6-month follow-up period, minority children cared for by trained providers showed greater reductions in impairment on the Strengths and Difficulties Questionnaire (-0.91 points) relative to those cared for by control providers but no greater reduction in symptoms. Seeing a trained provider had no impact on symptoms or impairment in white children.

Parents of children who saw a trained provider experienced greater reductions in symptoms on the General Health Questionnaire (-1.7 points) relative to those who visited a control provider.

"The impact of training on parent distress and child functioning was of similar magnitude as that reported for more-complex interventions," Dr. Wissow and colleagues note.

"If our results can be replicated, it opens up a new set of approaches to expanding access to mental health services via primary care," Dr. Wissow told Reuters Health.

Pediatrics 2008;121:266-275.