Pediatrician’s Silent Struggle: Perspectives on Behavioral Health Beyond the Check-Up

Overview

This report summarizes findings from interviews conducted with five pediatricians in Suffolk County, Long Island, NY, aimed at understanding their practices, challenges, and needs regarding children's mental and behavioral health. Outreach was conducted with thirty offices via phone and email, indicating an almost 17% response rate. This average  response rate for cold outreach may indicate some connection with the topic as well as  the potential time constraints and high patient volume these professionals face. The interviews revealed a consistent commitment to addressing behavioral health, alongside significant systemic and practical challenges.

Triggers and Methods for Behavioral Health Assessments

Pediatricians reported utilizing behavioral health assessments in response to a variety of triggers. These included parent/teacher reports of behavioral changes such as aggression, withdrawal, academic decline, impaired social functioning, emotional distress (anxiety, depression, etc.), developmental delays or regression, and the presence of risk factors like trauma or family history of mental health concerns. Routine wellness checks, particularly during adolescence or transitional life stages, also prompted assessments. Some practices employed standardized screening tools like the Pediatric Symptom Checklist (PSC), Strengths and Difficulties Questionnaire (SDQ), and Child Behavior Checklist (CBCL), often in conjunction with clinical interviews and observations. However, a significant variability in assessment practices was noted and solely symptom focused tools were utilized; no measures of mental wellbeing were identified. This aligns with the necessity of expanding the role of pediatricians in child health, including mental health (Kronick et al., 2009).

Challenges in Categorizing and Assessing Behavioral Health Issues

Pediatricians utilized a multi-faceted approach to categorize and organize behavioral health issues, combining standardized screening tools, clinical interviews, and reports from parents and teachers. The benefits of standardized tools were recognized, particularly for structuring conversations, tracking progress, and providing measurable benchmarks. However, time constraints were a significant challenge, limiting the ability to conduct thorough assessments. Additionally, resistance from families due to stigma, cultural beliefs, or language barriers hindered accurate assessment. This aligns with findings that cultural competency and addressing stigma are critical for effective mental health care delivery (Sue & Sue, 2016).

Overarching Pain Points and Systemic Barriers:

Overarching pain points included systemic barriers, emotional strain, and limited capacity. Pediatricians expressed frustration with long wait times for referrals to mental health specialists, insufficient community mental health resources, and a lack of post-assessment support for families. Addressing mental health concerns within short pediatric visits and navigating sensitive conversations with families was emotionally taxing. Furthermore, many pediatricians felt unequipped to meet the growing demand for mental health care. These findings reflect the broader issue of limited access to mental health services for children and adolescents in the United States (Kataoka et al., 2002).

The systemic barriers identified by Suffolk County pediatricians are consistent with national trends. For example, lengthy wait times for mental health specialist referrals are often attributed to a shortage of child and adolescent psychiatrists and psychologists, particularly in underserved areas (Meng & Wiznitzer, 2024). This shortage is exacerbated by insurance reimbursement challenges and the administrative burden of navigating complex referral systems, which discourage mental health professionals from participating in certain plans (Whitney & Peterson, 2019). Furthermore, insufficient community mental health resources, as highlighted by the interviewed pediatricians, reflect a broader pattern of underfunding for community-based mental health services, leading to a lack of accessible and affordable care options for families (National Academies of Sciences…, 2019). Finally, the emotional strain experienced by pediatricians stems from the difficult nature of addressing mental health concerns within the limited time constraints of typical pediatric visits, coupled with the frequent lack of adequate follow-up support. This often leaves pediatricians feeling responsible for managing complex cases without the necessary resources or expertise, contributing to burnout and a sense of professional inadequacy (Zarefsky, 2024).

Pediatrician-Identified Needs

Pediatricians identified several key needs, including improved access to mental health services, enhanced tools and training, and greater integration of care. They desired shorter wait times for referrals, increased availability of mental health professionals, streamlined referral pathways, and telehealth collaborations to expand access. Integrated digital tools for efficient screening and pre-visit questionnaires, user-friendly multilingual assessment platforms, and training opportunities to enhance cultural competence and communication skills were also requested. Greater integration between pediatric care and mental health services was seen as crucial for ensuring comprehensive and continuous support for children and families.

Alignment with MindArch Health’s MAP Software Capabilities

The capabilities of the MAP software were evaluated in relationship to the needs and challenges shared by the interviewed pediatricians to examine its feasibility. Its data-driven approach, designed to identify at-risk populations prior to the onset of any symptoms, and facilitate tailored interventions proactively, suggests MAP could be a valuable asset in addressing pediatricians’ specific needs. By providing a structured framework for conducting risk and needs assessments, planning, and identifying preventive interventions, MAP could potentially provide pediatricians a tool to overcome existing hurdles and deliver more effective, preventative mental healthcare to their patients. MAP’s focus on collaborative planning and continuous improvement further indicates that this tool could be a strong fit for a community facing complex systemic challenges. 

Specifically, the MAP software’s ability to facilitate data-driven decision-making through its comprehensive psychological health and needs assessments and reporting features could address the variability in assessment practices and the need for standardized, measurable benchmarks. The software's contextual analysis and multi-level stakeholder engagement could help overcome systemic barriers by identifying opportunities for mental health promotion, population health strategies and improve collaboration and resource optimization. Moreover, its predictive modeling capabilities and automated scoring could alleviate time constraints by streamlining the assessment and intervention process. The software’s training library and ability to identify protective factors and tailored solutions aligns with the pediatricians' desire for enhanced tools and training, which may allow them to provide more holistic and proactive care to their young patients, potentially reducing risk and rates of disorder.

Recommendations for Future Research

This report underscores the dedicated effort of Suffolk County pediatricians in tackling the mental health concerns of their young patients. However, their ability to deliver comprehensive care is significantly hampered by systemic impediments, resource scarcity, and time limitations. Overcoming these obstacles necessitates a collaborative, multi-pronged strategy, including expanded access to specialized mental health services, provision of advanced tools and training for pediatricians, and the seamless integration of pediatric and mental health care. To gain a more nuanced understanding and develop effective solutions, future research should incorporate a larger, more representative sample, and crucially, solicit input from the families directly impacted. Furthermore, future research efforts should specifically examine the capabilities of the MAP toolkit in addressing these identified needs. This includes evaluating its effectiveness in streamlining assessment processes, facilitating data-driven decision-making, and enhancing collaboration between pediatricians and mental health specialists. Research in these areas could explore how MAP's features, such as contextual analysis and predictive modeling, can be tailored to the specific challenges faced by pediatricians in Suffolk County, and how its implementation impacts patient outcomes and clinician satisfaction.

References

Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555. https://doi.org/10.1176/appi.ajp.159.9.1548 

Kronick, J. B., Hilliard, R. I., & Ward, G. K. (2009). The changing role of the paediatrician in the 21st Century. Paediatric Child Health, 14(5), 277–278. https://doi.org/10.1093/pch/14.5.277 

Meng, J. F., & Wiznitzer, E. (2024, October 10). Factors associated with not receiving mental health services among children with a mental disorder in early childhood in the United States, 2021–2022. Centers for Disease Control and Prevention. https://www.cdc.gov/pcd/issues/2024/24_0126.htm 

National Academies of Sciences, Engineering, and Medicine. (2019). Integrating social care into the delivery of health care: Moving upstream to improve the nation's health. National Academies Press.  

Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice, 7th edition. John Wiley & Sons. 

Whitney, D. G., & Peterson, M. D. (2019). US national and regional estimates of those born with mental, behavioral, or developmental disorders among children and adolescents. Journal of Developmental & Behavioral Pediatrics, 40(2), 82.

Zarefsky, M. (2024, January 8). Most pediatricians have burnout. Here's what it takes to fix that. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/most-pediatricians-have-burnout-here-s-what-it-takes-fix