ABSTRACT
To examine if an innovative collaborative care model known as Targeted Child Psychiatric Services designed for primary care pediatricians (PCPs) and child psychiatrists (1) was associated with improved access to child psychiatry services, (2) had the potential to identify optimal care settings for pediatric mental health care and (3) examined if pediatricians appeared as likely to accept children back into their practices at discharge from TCPS depending upon diagnostic category, controlling for severity of illness and function. The diagnostic classes examined were ADHD (39%), depression (31%) and anxiety (13%). This prospective cohort design study collected medical records of 329 children referred to TCPS by 139 PCPs. To detect the likelihood of return to referring pediatricians for follow-up care at discharge from TCPS, we employed logistic regression models. Mean age was 12.3 (SD = 4.0); 43% were female. Ninety-three percent of parents complied with pediatricians' recommendations to have their child assessed by a child psychiatrist. A total of 28.0% of referrals returned to PCPs for follow-up care; the remainder were followed in mental health. Regression findings indicated that children with major depression (OR = 7.5) or anxiety disorders (OR = 5.1) were less likely to return to PCPs compared to ADHD even though severity of psychiatric illness and functional levels did not differ across diagnostic groups. Families widely accepted pediatricians' recommendations for referral to child psychiatrists. Depression and anxiety were strong correlates of retention in mental health settings at discharge from TCPS though children with these disorders appeared to be no more severely ill or functionally limited than peers with ADHD. These children possibly could be managed in a less intensive and expensive primary care treatment setting that could access mental health specialty services as needed in a collaborative model of care. TCPS is contrasted with the well-known collaborative model for adult depression in primary care. TCPS could serve as a feasible model of care that addresses the daunting barriers in accessing pediatric mental health services.
Subject(s)
Cooperative Behavior , Health Services Accessibility , Mental Health Services , Pediatrics , Adolescent , Checklist , Child , Confidence Intervals , Female , Humans , Male , Mass Screening/instrumentation , Massachusetts , Odds Ratio , Prospective StudiesABSTRACT
This paper is concerned with the use of alcohol and folkloric medicine in migratory populations. Some field-research was undertaken as a systemic approach to reality in the district of La Matanza (Buenos Aires, Argentina). Considering a previous contribution presented by the author in reference to alcoholic families (Prize 1981, Journal of Family Therapy) findings highlight that alcoholism and folkloric medicine persist and increase insomuch as the possibilities for adjustment to a new culture decrease. Thus, social segregation of migratory populations increases. Finally, an interdisciplinary psychotherapeutic model is outlined.
Subject(s)
Alcoholism/psychology , Medicine, Traditional , Social Adjustment , Transients and Migrants/psychology , Argentina , HumansABSTRACT
This paper is concerned with the use of alcohol and folkloric medicine in migratory populations. Some field-research was undertaken as a systemic approach to reality in the district of La Matanza (Buenos Aires, Argentina). Considering a previous contribution presented by the author in reference to alcoholic families (Prize 1981, Journal of Family Therapy) findings highlight that alcoholism and folkloric medicine persist and increase insomuch as the possibilities for adjustment to a new culture decrease. Thus, social segregation of migratory populations increases. Finally, an interdisciplinary psychotherapeutic model is outlined.
Subject(s)
Mental Health , Primary Prevention , Systems Theory , Child Development , Child, Preschool , Community Psychiatry , Group Processes , Humans , Learning , Nurseries, Infant , TeachingABSTRACT
La prevencion primaria debe actuar sobre los recursos generales de una comunidad reduciendo las condiciones perjudiciales antes de que tengan oportunidad de provocar enfermedad. Se establecio asi un modelo tomado de la Teoria General de los Sistemas que marco las condiciones relevantes para desarrollar en el area educativa un servicio preventivo comunitario adecuado
Subject(s)
Child, Preschool , Humans , Community Psychiatry , Mental Health , Primary Prevention , Child DevelopmentABSTRACT
La prevencion primaria debe actuar sobre los recursos generales de una comunidad reduciendo las condiciones perjudiciales antes de que tengan oportunidad de provocar enfermedad. Se establecio asi un modelo tomado de la Teoria General de los Sistemas que marco las condiciones relevantes para desarrollar en el area educativa un servicio preventivo comunitario adecuado
