Study: Most parents prefer children's mental health screening done in primary care setting

Key takeaways:

• Ninety-three percent of respondents wanted children screened at regular intervals in primary care settings.
• Screening topics that parents showed less comfort with included firearms and substance use.

Most parents showed a willingness for their child to have mental health screening assessments done in a primary care setting and were generally comfortable with screening topics, a recent study found.

With the state of youth mental health being declared a national emergency by several organizations, improved detection of mental disorders has become an increasing priority, Mirelle Kass, BA, a research projects coordinator at the Child Mind Institute in New York, and colleagues wrote in JAMA Network Open.

This has become especially true in primary care settings, where “work has found that mental health referrals from [primary care physicians] are preferred and result in a higher follow-up rate compared with referrals from other parties,” the researchers wrote.

They added, however, that most research on acceptability and preferences regarding screenings have been focused on medical staff, rather than parents and caretakers.
To understand parents’ attitudes — a critical component to optimize screening — Kass and colleagues conducted a survey study with 972 parents and caregivers from 19 countries.

Participants had at least one child, had a mean age of 39 years and were 62.3% women. Of the respondents, 27.2% and 29% were from the United States and United Kingdom, respectively.

The survey inquired about several aspects of screenings, including a willingness to discuss mental health, comfort levels with screening topics and assessment methods. Participants rated their agreement or comfort on a 6-point Likert scale, with 6 representing the highest level of agreement or comfort.

Overall, 92.1% of respondents said they wanted their children screened for mental health problems at regular intervals, whereas annual screening was preferred by 64.9%.

Meanwhile, 89.7% of participants were most willing to speak about children’s mental health screenings with a physician, followed by a psychologist (76.4%). U.S. participants had the highest willingness to speak with a physician, at 95.5%.

Kass and colleagues also found that participants showed lower comfort with home-based assessments vs. office-based assessments and significantly decreased comfort with child self-reported assessments compared with parent-reported assessments. For every 1-year increase in a child’s age, parent comfort levels increased.

Although comfort levels for each of the screening topics differed, participants were generally comfortable with all topics, with a mean Likert score range of 4.13 to 5.3.

The topic with which parents were most comfortable was sleep disorders (mean [SE] score = 5.3), whereas topics that parents showed the least comfort with included:

• firearms (mean [SE] score = 4.71);
• substance use and use disorders (mean [SE] score = 4.68);
• gender identity (mean [SE] score = 4.68); and
• suicidality (mean [SE] score = 4.62).

The study pointed to “potential areas” for optimizing screening, including home-based screenings, which can “minimize workflow interruptions and time costs associated with screening,” the researchers explained.

“As web-based screening assessments become more widely available and are integrated into electronic health record systems, health care offices may consider this route of administration,” they wrote. “This may also allow for increased frequency of screenings, as certain mental illnesses are known to fluctuate by season, suggesting that annual screening may not be sufficient for all disorders.”

Additionally, the fact that parents showed more comfort with screening and interpretation of results by medical professionals suggests that “school-based efforts may benefit from either having a medical or psychological professional on site” for the purposes of screening children for mental health problems, the researchers added.

Ultimately, “increased efforts toward the education of parents about the potential benefits and risks of screening may help to increase comfort levels for more comprehensive screening processes,” Kass and colleagues wrote.