• Jane Williams, Kurt Klinepeter, Guy Palmes, Anita Pulley, and Meschan FoyJaneJ.
• Department of Pediatrics, Wake Forest University, Winston-Salem, NC 27157-1060, USA. janewill@wfubmc.edu
• Clin Pediatr (Phila). 2007 Jun 1; 46 (5): 424-30.

AbstractA standard guide was readministered to 42 primary care pediatricians after community interventions to assess changes in their behavioral health practices. Among the outcome findings: increased screening of young children (6 months to 5 years); attention deficit hyperactivity disorder continued to be the most frequent diagnosis, with a high level of diagnostic comfort and use of stimulants; decreased comfort in the diagnosis and treatment of depression, with a significant decline in use of selective serotonin reuptake inhibitors; nearly all continued to offer nonmedication, behavioral health treatment; and a significant increase in use of social workers for community referrals. Structured interventions had limited influence on the process of change. Black box warnings exerted a powerful effect on prescribing practices. Systemic changes involving financial incentives, increased access to mental health providers, practice guidelines, and technology for continuing education may offer possibilities for changing practice patterns.

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