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Commentary: promoting health and well-being in pediatric primary care settings: using health and behavior codes at routine well-child visits.

Pediatric primary care provides an optimal setting for the practice of pediatric psychology and the use of health and behavior codes to capture this practice. Pediatric primary care settings provide continuous and comprehensive medical services that are readily accessible to the vast majority of children in the United States and their families (Centers for Disease Control, 2004). These settings are ideally suited to promote optimal development and well-being through the provision of expanded services that address parental concerns, developmental tasks, psychosocial factors, and behavioral health issues in the context of trusting relationships with familiar providers. Pediatric psychologists integrated into primary care settings are able to promote health and well-being of children and families in a manner directly aligned with the mandates and guidelines of the practice of pediatric primary care (American Academy of Child and Adolescent Psychiatry and American Academy of Pediatrics, 2009). Pediatric primary care is often the only available port of entry into service systems for vulnerable children and their families. Although the American Academy of Pediatrics (AAP) and Bright Futures provide systematic guidelines and outline methods for comprehensive surveillance and screening during well-child checks, most pediatric practices and providers are overwhelmed by the complex risk factors presented during ‘‘routine’’ visits lasting an average of 18 min (Olson et al., 2004) and may be reluctant to solicit information about behavioral and psychosocial matters because they are unable to adequately address them or receive reimbursement for treating them (American Academy of Child and Adolescent Psychiatry and American Academy of Pediatrics, 2009). Consequently, children facing significant risk factors that impinge upon development and profoundly impact family functioning remain unidentified. Even when risk or early disturbance is identified, families often have difficulty accessing necessary community resources. Pediatric psychologists in primary care engage in activities that ‘‘improve the health-related quality of life of children and their families’’ (Noll & Fischer, 2004). Such activities include: (a) promoting health and well-being and providing anticipatory guidance during routine well-child visits; (b) screening, early identification, and referral around developmental and behavioral health issues; (c) providing early treatment for issues that, left untreated, could lead to significant impairment; and (d) triaging, referring to, and coordinating with community resources when higher levels of care are necessary. Pediatric psychologists help improve adherence, promote healthy behaviors and reduce behaviors that increase health risks, and improve communication between healthcare providers and the children and families they serve (Noll & Fischer, 2004).