The following article is a part of conference coverage from the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30 to October 4, 2020. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurses in psychiatry. Check back for more from APNA 2020.


Despite acknowledging the importance of screening for behavioral health concerns when surveyed, only 39.1% of pediatric primary care providers working in a rural area report screening for developmental delays, according to a poster presented at the American Psychiatric Nurses Association 34th Annual Conference, held online from September 30th to October 4th, 2020.

Mental health disorders occur in approximately 20% of children in the United States, and approximately  36% to 39% will have a behavioral health disorder diagnosed by the time they are 16, reported Therese Mathews, PhD, an associate professor from the University of Nebraska Medical Center College of Nursing. “Rural residents particularly face extensive barriers to accessing behavioral health services resulting in significant health disparities for many families,” she added.

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To study how many clinicians follow the American Academy of Pediatrics recommendations for mental health screening, Dr Mathews and colleagues distributed a survey to 300 primary care providers to assess their current behavioral health screening practices for patients aged 6 months to 18 years. After 110 surveys were completed and returned, the study authors analyzed the results by provider type, screening instrument, and screening tool usage. The majority of respondents were physicians (67% MDs and 3% DOs); 16% were nurse practitioners and 14% were physician assistants.

The data revealed the majority of providers screen for autism and depression; however, less than 40% of providers screen for development and other behavioral concerns. Clinicians reported using the following screening tools: Ages and Stages (39.1%), Modified Checklist for Autism in Toddlers (M-CHAT, 61.8%), Patient Health Questionnaire (PHQ-9, 76.4%), Pediatric Symptom Checklist-17 (6.4%), Edinburgh Postnatal Depression Scale (43.6%), Strengths and Difficulties Questionnaire (1.8%), and Screen for Child Anxiety Related Disorders (SCARED, 11.8%).

A majority (69.2%) of pediatric clinicians stated they “always” use behavioral health screening tools, compared with 6.7% of family/internal medicine providers. Only 1.5% of pediatric clinicians stated that they never use behavioral health screening tools, compared with 17.8% of family practice clinicians.

When asked how important it is to screen for behavioral health issues, the most common answer for both pediatric and family providers was “extremely,” (53.1% and 42.2%, respectively), followed by “very,” (30.8% and 40%, respectively). However, this endorsement of behavioral health screening practices is not reflected in the amount of providers who screen for developmental delays in accordance with developmental-specific tools (39.1%).

Researchers noted that for 80.9% of respondents, there was a behavioral health care provider available in the clinic. Therefore, these findings may not be generalized to other rural clinics.

“Although most providers believe it is important to screen for developmental and behavioral issues in primary care, the frequency of screening are below recommendations for surveyed providers,” the study authors said. “Consideration of integrated behavioral health collaborative care models, using APRNs and behavioral health care providers are indicated to assist with screening and referral mechanisms for follow-up.”

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Mathews T, Roberts H, Klepper C, Paff M, Jordan P, Mullarkey J. Screening for behavioral health in pediatric primary care. Presented at: APNA 34th Annual Conference; September 30 to October 4, 2020. Poster 87.