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Are Pediatricians Doing More Family “Therapy” Than They Realize? Changing Families Through Single Encounters

In the past decade, there has been an increasing recognition by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry of the need for pediatricians to improve competencies in assessing and treating behavioral health issues. 1The increased efforts dedicated to pediatrician education in behavioral health has resulted in significantly improved access to mental health services.2 A large proportion of children receiving services for behavioral health problems are now managed in primary care settings. 3 
 
Despite these advances, surveys of pediatricians have demonstrated that while many recognize their role in identifying behavioral health problems, there are many pediatricians who are not regularly treating these disorders.4 They may not see treatment as their role or they may feel they lack the expertise, and time to provide these services. 4 Results of the American Academy of Pediatrics 2009 periodic survey revealed that less than one-third of the 1600 pediatricians surveyed saw it as their role to manage mental health issues beyond ADHD.3 
 
Although some pediatricians don’t feel prepared to provide behavioral health care or see this as their role, a number of researchers have pointed out that some pediatricians possess many qualities that make them well-suited to provide such services.1The medical home literature has also cited the value of providing behavioral and mental health services in the pediatric setting, where there is less stigma, high levels of trust, and more familiarity for families.1,2,5 
 
A qualitative analysis of semi-structured interviews with families was conducted to understand the parents’ expectations regarding the role of pediatricians in regards to behavioral health care. This qualitative analysis was part of a mixed-methods study of 55 parents whose children were referred for mental health care by their pediatrician; 36 of these 55 parents participated in a semi-structured interview. Parents were asked about their previous experience with the pediatrician providing behavioral health care, what role they see their pediatrician as playing in regards to the child’s behavioral health, the clinical encounter that resulted in a referral, and the parent’s reaction to these interventions. These interviews were analyzed using grounded theory methods by three independent coders. Through the analysis, themes emerged, out of which a code book was developed. Consensus regarding the themes was obtained through group discussion. 
 
An interesting theme entitled “truth discovery” emerged from the interviews, in which a number of families were reporting changes in the family dynamics and family structure through one clinical encounter with the pediatrician. In this report, we illustrate this process, which we are calling “family truth discovery,” by describing in some detail two parents’ accounts of the clinical encounter with the pediatrician. The pediatrician’s interaction with the child and family members was instrumental in revealed some truth in the family that was not known previously, altering the family dynamics that had been playing a role in the child’s behavioral health symptoms.