Factors Influencing Pediatric Primary Care Providers’ Perceived Capacity to Address Behavioral Health Needs

OBJECTIVE: Pediatric primary care providers (PPCPs) often report discomfort with managing behavioral health issues. Child psychiatry access programs (CPAPs) offer psychiatric consultation, education, and referral support. This exploratory, sequential mixed-methods study aimed to identify factors influencing PPCPs' perceived ability to manage behavioral health issues and the impact of these factors on PPCPs' use of psychiatric consultation from California's CPAP. METHODS: Focus group data from 11 pediatric practices (N=52 PPCPs) were analyzed to identify factors shaping PPCPs' perceived ability to address behavioral health issues. Consultations (N=188) involving the participating practices (March 2022-April 2024) were analyzed for their purpose, patients' demographic and clinical characteristics, and disposition (i.e., ongoing management in primary care or referral to specialty behavioral health care). Logistic regression was used to examine factors associated with disposition. RESULTS: PPCPs felt somewhat capable of managing care for patients with attention-deficit hyperactivity disorder (ADHD), depression, or anxiety and for those receiving psychotherapy, but they felt less capable when patients had multiple psychiatric diagnoses or clinical risk factors such as suicidal ideation. Many PPCPs reported discomfort with initiating or changing psychotropic medications. Seventy percent of consultations were related to medication. Consultations resulted in disposition to primary care management for 72% of patients, and this disposition was positively associated with an ADHD, a depression, or an anxiety diagnosis (adjusted odds ratio [AOR]=4.90) and younger patient age (≤11 years; AOR=2.58) but negatively associated with clinical risk factors (AOR=0.31). CONCLUSIONS: Availability of psychiatric consultation via CPAPs may enhance PPCPs' ability to manage behavioral health issues within primary care.