Using vignettes to assess contributions to the work of addressing child mental health problems in primary care

Lawrence S Wissow, Waleed Zafar, Kate Fothergill, Anne Elizabeth Ruble, Eric Slade

Research output: Contribution to journalArticle

Abstract

Background: To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Methods: Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77 % female, 58 % at their site 10 or more years; 44 % in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. Results: The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50 %) increase in work (95 % CL.94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P <.001) while medical co-morbidity increased it the least (.44 units, p <.001). Factors most strongly associated with increased overall work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work ratings than did those without co-located staff. Conclusions: Both diagnosis and cross-diagnosis complicating factors contribute to the work involved in providing mental health services in primary care. Vignette studies may facilitate understanding which mental health services can be most readily incorporated into primary care as it is presently structured and help guide the design of training programs and other implementation strategies.

Original languageEnglish (US)
Article number1237
JournalBMC Health Services Research
Volume15
Issue number1
DOIs
StatePublished - Jan 22 2016

Fingerprint

Primary Health Care
Mental Health
Morbidity
Mental Health Services
Physicians
Psychiatry
Anxiety
Depression
Delivery of Health Care
Physical Exertion
Child Health
Private Practice
Malpractice
Workload
Linear Models
Pediatrics
Education
Surveys and Questionnaires
Pediatricians

Keywords

  • Children
  • Collaborative care
  • Mental health
  • Primary care
  • Survey
  • Task shifting
  • Vignettes

ASJC Scopus subject areas

  • Health Policy

Cite this

Using vignettes to assess contributions to the work of addressing child mental health problems in primary care. / Wissow, Lawrence S; Zafar, Waleed; Fothergill, Kate; Ruble, Anne Elizabeth; Slade, Eric.

In: BMC Health Services Research, Vol. 15, No. 1, 1237, 22.01.2016.

Research output: Contribution to journalArticle

@article{70343f75aaff4a8ba96335a93c5d642f,
title = "Using vignettes to assess contributions to the work of addressing child mental health problems in primary care",
abstract = "Background: To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Methods: Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77 {\%} female, 58 {\%} at their site 10 or more years; 44 {\%} in private practice, 52 {\%} urban, 48 {\%} practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. Results: The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50 {\%}) increase in work (95 {\%} CL.94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P <.001) while medical co-morbidity increased it the least (.44 units, p <.001). Factors most strongly associated with increased overall work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work ratings than did those without co-located staff. Conclusions: Both diagnosis and cross-diagnosis complicating factors contribute to the work involved in providing mental health services in primary care. Vignette studies may facilitate understanding which mental health services can be most readily incorporated into primary care as it is presently structured and help guide the design of training programs and other implementation strategies.",
keywords = "Children, Collaborative care, Mental health, Primary care, Survey, Task shifting, Vignettes",
author = "Wissow, {Lawrence S} and Waleed Zafar and Kate Fothergill and Ruble, {Anne Elizabeth} and Eric Slade",
year = "2016",
month = "1",
day = "22",
doi = "10.1186/s12913-015-1237-x",
language = "English (US)",
volume = "15",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Using vignettes to assess contributions to the work of addressing child mental health problems in primary care

AU - Wissow, Lawrence S

AU - Zafar, Waleed

AU - Fothergill, Kate

AU - Ruble, Anne Elizabeth

AU - Slade, Eric

PY - 2016/1/22

Y1 - 2016/1/22

N2 - Background: To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Methods: Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77 % female, 58 % at their site 10 or more years; 44 % in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. Results: The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50 %) increase in work (95 % CL.94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P <.001) while medical co-morbidity increased it the least (.44 units, p <.001). Factors most strongly associated with increased overall work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work ratings than did those without co-located staff. Conclusions: Both diagnosis and cross-diagnosis complicating factors contribute to the work involved in providing mental health services in primary care. Vignette studies may facilitate understanding which mental health services can be most readily incorporated into primary care as it is presently structured and help guide the design of training programs and other implementation strategies.

AB - Background: To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Methods: Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77 % female, 58 % at their site 10 or more years; 44 % in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. Results: The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50 %) increase in work (95 % CL.94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P <.001) while medical co-morbidity increased it the least (.44 units, p <.001). Factors most strongly associated with increased overall work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work ratings than did those without co-located staff. Conclusions: Both diagnosis and cross-diagnosis complicating factors contribute to the work involved in providing mental health services in primary care. Vignette studies may facilitate understanding which mental health services can be most readily incorporated into primary care as it is presently structured and help guide the design of training programs and other implementation strategies.

KW - Children

KW - Collaborative care

KW - Mental health

KW - Primary care

KW - Survey

KW - Task shifting

KW - Vignettes

UR - http://www.scopus.com/inward/record.url?scp=84960499427&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960499427&partnerID=8YFLogxK

U2 - 10.1186/s12913-015-1237-x

DO - 10.1186/s12913-015-1237-x

M3 - Article

C2 - 26801906

AN - SCOPUS:84960499427

VL - 15

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 1237

ER -