Characterizing Referrals to Mental and Behavioral Health and Community Resources in Urban Pediatric Primary Care.

Abstract

Objective: Examine patient characteristics and practice processes associated with referrals to social and behavioral health resources in an urban/inner-city primary care pediatric practice.

Method: Retrospective chart review was conducted on Safe Environment for Every Kid (SEEK) screening and immediate and later clinician responses to positive screens (documented by the practice's early relational health specialist) from well-child visits for children 6 months to 6 years. Bivariate and multivariate analyses were used to examine associations between demographics, screening results, and referral acceptance.

Results: Of 1104 SEEK screens, 152 (13.8%) were excluded for incomplete screens and 25 (2.3%) for duplicate caregiver screens. Of 927 included, responses were discussed at the time of screening for 286 (30.9%, "immediate") and/or attempted to be discussed at a later time by phone for 397 (42.8%, "later," median 11 days [interquartile range 6-19] between screen and discussion); 14 (1.5%) had both forms of contact; and 230 (24.8%) had no documented discussion at any time. Demographics were similar across groups. Clinician discussion was more likely if caregivers reported harsh punishment (p = 0.036), caregiver stress (p < 0.001), or caregiver depression (p < 0.001) on screen. After clinician discussion, referral was offered and subsequently accepted by 225 of 697 caregivers (32.3%). Each additional stressor endorsed increased odds of accepting referral by 25% (95% confidence interval, 1.07-1.47). Referrals to parenting groups, social needs navigation support, and social work were completed by 33 of 68 (48.5%) referred families.

Conclusion: Safe Environment for Every Kid screening in urban pediatric primary care can be used to identify families' unmet social and behavioral health care needs to provide support.