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Psychosocial interventions for use in pediatric primary care: an examination of providers' perspectives.

Introduction: The integration of psychosocial interventions in primary care settings is 1 mechanism to increase access to mental health care to youth in need. Although the delivery of psychosocial interventions by primary care providers (PCPs) reflects 1 example of this integration, research indicates that various barriers to implementation by PCPs exist. With the goal of informing a framework to guide the selection of treatments amenable to PCP practice, the authors sought to examine which criteria might influence a PCP's intention to use a given psychosocial intervention. Method: Using survey methodology, 49 PCPs ranked characteristics of interventions for feasibility and applicability to their patient populations and setting. Results: Survey respondents found the following characteristics most important: time to employ, applicability to multiple disorders, ease of use, and ease of learning. Providers who endorsed more negative beliefs and attitudes toward addressing psychosocial concerns in youth were more likely to see certain criteria, such as ease of use and ease of learning, as more important. Discussion: The authors illustrate the potential application of these findings to the selection of psychosocial interventions for use in primary care and discuss future research directions.

Keywords: primary care, mental health, children and adolescents, integrated behavioral health care

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A tremendous gap exists between the mental health needs of children and adolescents in the United States and access to services (Merikan gas et al., 2010). One proposed solution for addressing this gap involves incorporating psychosocial treatment into the primary care setting (World Health Organization, 2005). In the United States, most children and adolescents visit a primary care provider (PCP) annually, making this a nearly universal setting for addressing mental health concerns (World Health Organization, 2005). In addition, primary care settings offer a less stigmatizing environment to address challenges than traditional outpatient mental health settings (Hagan, Shaw, & Duncan, 2008; Kolko, 2009). Finally, the primary care setting provides an opportunity for continuous care, as PCPs often have opportunity for long-term follow-up with both the patient and the family (Bray, Frank, McDaniel, & Heldring, 2004).

In response to the interest in delivering mental health care in primary care settings, several models of integration have been developed, in eluding colocation of mental health providers and direct psychosocial treatment delivered by PCPs (American Academy of Child and Adolescent Psychiatry, 2010). While colocated models offer PCPs and families an accessible, convenient mechanism for obtaining mental health care, and reduce the risk of failed referrals to community-based mental health providers (Williams, Shore, & Foy, 2006), financial challenges and limited availability of specialty providers make this model difficult to execute universally. Further, related to the stigma of mental illness, certain youth and families may prefer to obtain support from their pediatric PCP rather than from a mental health specialist (Hagan et al., 2008). In addition, for youth with problems whose needs may not require a referral to a mental health provider, intervention by the PCP may be appropriate (World Health Organization, 2005). Thus, in addition to the use of colocated care, many have advocated capitalizing upon PCPs' unique strengths and opportunities to identify and address their patients' unmet mental health needs (Kolko & Perrin, 2014). When provided with appropriate training and support, PCPs can effectively identify and treat a number of their patients' mental health problems (National Institute of Health Care Management, 2009).

Yet, multiple challenges to transporting evidence-based psychosocial interventions into the primary care setting for use by PCPs exist, including aspects of the treatments themselves and provider attitudes and training. Many manualized, evidence-based treatments (EBTs) involve multisession interventions that require more time per session and more follow-up contact than is typical in the primary care setting (Rotheram-Borus, Swendeman, & Chorpita, 2012). In addition, many EBTs are designed for the treatment of a single mental health disorder, yet a significant number of youth present to primary care settings with comorbid concerns (Briggs-Gowan, Horwitz, Schwab-Stone, Leventhal, & Leaf, 2000). Further, a high number of patients seen in primary care for mental health problems present with considerable impairment without meeting criteria for a diagnosis (Briggs-Gowan et al., 2003). Current EBTs, for the most part, are not designed to address these unique needs of the primary care setting.

In addition to concerns with manualized psychosocial interventions, PCPs' beliefs about their role in the delivery of psychosocial treatment and lack of confidence in addressing mental health concerns represent substantial challenges to the integration of mental health care in primary care settings (Brown, Wissow, & Riley, 2007). Although more than 80% of PCPs indicate that they view themselves as being responsible for addressing mental health concerns with their patients (Stein et al., 2008), excluding cases of attention deficit hyperactivity disorder (ADHD), most believe their role should be limited to detection and referral rather than treatment or management of mental health problems (Stein et al., 2016). Further, most PCPs do not receive advanced training in development and behavior (Horwitz et al., 2007). Thus, although there is a need for PCPs to deliver psychosocial interventions directly, certain limitations exist.

One potential solution involves the adaptation of what has been termed a modular approach to treatment (Chorpita & Weisz, 2009; Weisz et al., 2012). Although most manualized EBTs for child mental health problems involve specific content delivered in a fixed sequence, a modular approach guides clinicians through a series of evidence-informed decisions to select and deliver discrete treatment components tailored to patient concerns (e.g., primary problem, comorbidity) and characteristics (e.g., age, gender, ethnicity; Chorpita & Daleiden, 2014; Chorpita, Daleiden, & Weisz, 2005). These components, or "practice elements," (e.g., psychoeducation, problem solving, praise, timeout, exposure) are distilled treatment components of effective interventions (Chorpita et al., 2005) that can be individualized and flexibly applied flexibility within the context of evidence-based decision-making (Chorpita & Daleiden, 2014). Thus, rather than demanding a diagnosis and selection of a corresponding EBT, an aggregated set of practice elements and a modular treatment approach could potentially be used to address the needs of, for instance, patients presenting with comorbid, subclinical concerns, or concerns that do not fit any specific treatment manual (Chorpita & Daleiden, 2014).

A modular treatment approach has demonstrated effectiveness in outpatient mental health settings (Chorpita et al., 2013; Weisz et al., 2012). Moreover, mental health providers appear to prefer modularized treatments to traditional manualized interventions (Borntrager, Chorpita, Higa-McMillan, & Weisz, 2009).

Further, preliminary evidence suggests that modular interventions might be feasible and effective in primary care settings (Kolko, Campo, Kelleher, & Cheng, 2010), though interventions were delivered by nurses and only addressed youth disruptive behavior concern. Thus, there is still much to be learned about the possible use of modular interventions by PCPs, including which practice elements might be most suited for delivery in primary care, which might be most readily adopted by PCPs, and how selected components might need to be modified for use in the primary care setting.

As provider preference seems critical to advancing the use of psychosocial interventions in primary care settings (Brown et al., 2007), we sought to take a first step toward addressing these questions through a survey of practicing PCPs. Specifically, with the goal of informing a framework to guide the selection of treatments that might be feasible and acceptable for use by PCPs, we examined which criteria might influence PCPs' intentions to use a given psychosocial intervention. Further, given previous research on the importance of provider attitudes in determining openness toward integration (Stein et al., 2016), we sought to examine whether PCPs' perceptions of the feasibility and acceptability of these criteria differed based on beliefs and attitudes toward addressing psychosocial concerns. We hoped to eventually apply these findings to the selection and development of treatment procedures for use by pediatric PCPs in primary care settings.

Method

Procedure

Data collection was part of a larger study investigating U.S. PCPs' perceptions of the work involved in caring for youth with mental health problems (Wissow, Zafar, Fothergill, Ruble, & Slade, 2015). PCPs (i.e., physicians' assistants, nurse practitioners, and physicians) who identified as having engaged in clinical care over the past 5 years were eligible to participate. After obtaining IRB approval, recruitment occurred via the membership list of a state chapter of the American Academy of Pediatrics (AAP) in the northeastern United States. The state chapter sent letters to all members describing the purpose of the study and alerting potential participants that they would be receiving an email with a link to the survey. After this initial email, the chapter sent three reminders emails. Both the recruitment email and survey included the eligibility criteria.

The mailing list included approximately 900 individuals, one third (n = 300) of whom were estimated by the chapter to no longer be practicing. Of those remaining (n = 600). the number of eligible members was unknown. However, in 2008, state estimates indicated that there were approximately 540 pediatricians practicing primary care in this particular state (Governor's Workforce Investment Board, 2011). In 2005, the AAP estimated that 80% of pediatricians nationally were members of the organization (Sand et al., 2005), with comparable specialty physician societies reaching 50-70% of potential members (Ferris, Vogeli, Marder, Sennett, & Campbell, 2007). As such, the number of possible eligible participants was estimated to range from 270 to 430; thus, we estimate our sample size of 49 individuals represents a completion rate of approximately 11-18%. This response rate is comparable to online survey research with PCPs (Rodriguez et al., 2006). Participants were entered into a drawing for a gift card as an incentive for completing the survey. Qualtrics Survey Software was used to create and distribute the surveys. Informed consent was obtained prior to completion of the survey and survey responses were anonymous.

Participants

Participants (n = 49) were mostly female (74%). The majority of participants had a doctorate of medicine (MD) (92%), though a few participants had a doctorate of osteopathic medicine (DO; 4%) or nurse practitioner degree (NP; 2%). Further, all endorsed a primary specialty in pediatrics (100%), though additional specialties were endorsed (e.g., family practice, internal medicine). The majority had no previous training in child behavior or therapy (64%). Approximately 44% of providers were housed in independent practice, whereas 34% were in hospitals or hospital-owned primary care facilities. In addition, 48% of providers had colocated mental health providers and were located in urban (48%) or suburban (42%) areas. (See Table 1.)

Measures

Physician Belief Scale. The modified, 14-item version of the Physician Belief Scale (PBS; McLennan, McWilliams, Comer, Gardener, & Kelleher, 1999) was used to measure PCPs beliefs and attitudes toward psychosocial aspects of patient care. The modified PBS is comprised of 14 items in two subscales: (a) Belief and Feeling Subscale, or the PCPs' thoughts about their ability to address psychosocial concerns and their perceptions of patients' desires to discuss such concerns (eight items) and (b) Burden Subscale, or PCPs' perceptions of the onus related to addressing psychosocial concerns (six items). Response options range from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating negative beliefs and attitudes. Total scores range from 14 to 70, with scores on the Belief and Feeling Subscale ranging from 8 to 40 and scores on the Burden subscale ranging from 6 to 30. Although there are no standardized criteria upon which to compare PBS scores, mean PBS Belief and Feeling and Burden subscales reported in the literature range from 12.80 and 15.30, respectively (McLennan et al., 1999) to 14.26 and 17.35, respectively (Brown et al., 2007; Brown & Wissow, 2008). The modified PBS has good reliability and validity (McLennan et al., 1999). Internal consistency of the PBS and the two subscales (Total Score = .78; Belief and Feeling = .79; Burden = .69) in this sample was acceptable.

PCP Mental Health Intervention Survey. We developed the PCP Mental Health Intervention Survey to assess PCPs' perception of criteria important to a PCPs' intention to use psychosocial interventions. Existing literature on the topic and input from a multidisciplinary team of researchers and providers with specialties in mental health integration in pediatric primary care guided the selection of the criteria. We undertook an iterative process of survey development, during which an initial pool of 21 criteria were presented to experts from pediatrics, psychiatry, psychology, social work, and nursing with experience in integrated mental health practice and research (n = 12) during two meetings. The final 10 criteria related to (a) feasibility within the pediatric primary care setting (four items); (b) training and comfort of the PCP (two items); and (c) patient and family characteristics (four items; see Table 2).

Using a 4-point Likert scale from 1 (not at all) to 4 (a lot), participants rated how much the criterion would impact their use of psychosocial interventions. Both the terms "common mental health concerns" (i.e., "ADHD, anxiety, depression") and "psychosocial interventions" (i.e., counseling about child behavior) were defined for participants. Participants were also permitted to add their own criteria to the list. Further, participants ranked the three criteria that would have the greatest impact on the likelihood they would use a psychosocial treatments.

Data Analyses

We calculated descriptive statistics for participating providers and practices. We analyzed rankings of criteria to examine which characteristics were more frequently ranked as important. We analyzed ratings of criteria to examine whether they differed based on provider beliefs and attitudes, as well as certain demographic variables. Finally, we conducted relevant significance tests (i.e., correlations and t tests) and post hoc analyses.

Results

The mean total PBS score for the sample was 30.31 (SD = 6.78, range = 15 to 45) and mean item score was 2.16 (SD = .48, range = 1.07 to 3.21), indicating somewhat positive overall beliefs and attitudes toward addressing psychosocial concerns in youth. The PBS mean Belief and Feeling subscale score was 12.92 (SD = 3.82, range = 8 to 24), whereas the Burden subscale was 17.39 (SD = 4.32, range = 6 to 24), again indicating moderately positive beliefs about their ability to address psychosocial concerns and their perceptions of patients' desires to discuss such concerns, as well as perceptions of the onus related to addressing psychosocial concerns, respectively. Finally, no statistically significant differences in PBS scores across provider categories (e.g., presence of colocated providers, location) were found.

Additional results are presented addressing the two aims of the study: (a) to examine which criteria influences PCPs' intentions to use a given psychosocial intervention and (b) to assess whether PCPs' ratings of the criteria differed based on beliefs and attitudes toward addressing psychosocial concerns.

With regards to the first aim, we analyzed rankings of the criteria to ascertain providers' perceptions of the relative importance of various criteria when considering the use of psychosocial interventions. "Time" was overwhelmingly the most common of the criteria ranked as having the greatest potential impact on choosing an intervention, being ranked among the top three by almost 80% of the providers. The next most commonly ranked criteria were "applicable to multiple disorders," with almost 49% of providers including this criteria in their ranking of the top three, and "ease of use," with approximately 39% of providers including this criteria in their rankings. (See Table 3 for additional rankings.)

With regards to the second aim, several significant correlations emerged between beliefs and attitudes toward addressing psychosocial concerns in youth and ratings of criteria (see Table 4). PCPs' beliefs and attitudes toward addressing psychosocial concerns in youth were both related to PCPs' assigning importance to whether an intervention would require multiple follow-up visits as important (r = .33, p < .05 and r = .32, p < .05, respectively). In other words, as negative beliefs and attitudes toward addressing psychosocial concerns increased, concerns about an intervention requiring multiple visits increased. Further, PCP attitudes toward addressing psychosocial concerns in youth (i.e., Burden) were associated with valuing the ease of learning an intervention, r = .29, p < .05. As PCPs held more negative attitudes toward addressing psychosocial interventions, they rated ease of learning an intervention as more important. In addition, PCP attitudes toward addressing psychosocial concerns in youth (i.e., Burden) were also related to rating as important how challenging an intervention would be for the patient/caregiver to use, r = .46, p < .01. That is, as PCPs held more negative attitudes toward addressing psychosocial interventions, they rated the ease of implementation by patients/caregivers as more important.

Discussion

To improve the ability of PCPs to address children's mental health, we examined criteria deemed important by PCPs that might influence their intention to use psychosocial interventions. In the current study, PCP rankings of criteria of psychosocial interventions high lighted the importance of attending to time constraints, applicability to multiple disorders, and ease of use when considering psychosocial interventions. Also underscored by the results was the relative importance of the ability to have psychosocial interventions that could be easy for PCPs to learn, easy for patients/caregivers to implement, and that would not require multiple visits. These findings are consistent with previous research highlighting the importance of developing interventions which take into account the PCPs limited time, address those concerns most likely presenting in the PCPs patient population, and do not require multiple visits to implement (Ginsburg, Drake, Winegrad, Fothergill, & Wissow, 2016; Wissow, Gadomski et al., 2008), though extend previous research by underscoring PCPs' perceptions of feasibility and acceptability as they relate to the use of psychosocial interventions in the primary care setting.

Results further indicated that providers with relatively negative beliefs and attitudes toward addressing psychosocial concerns in youth are more likely to see certain criteria as more important than those with positive beliefs and attitudes (e.g., greater concerns with interventions requiring multiple visits; preferring interventions that are easy to learn and easy for patient/ caregiver to use). This may be the result of previous unsuccessful attempts to address mental health concerns in their practice. These findings are consistent with previous research supporting the importance of provider beliefs and attitudes (Brown et al., 2007; Stein et al., 2016) and may be used to inform interventions targeting provider beliefs and attitudes as a way to enhance provider readiness to adopt treatment components for patient psychosocial concerns.

Limitations

Study findings must be interpreted with the following limitations in mind. Participants were sampled from one northeastern state that may have lower rates of mental health concerns and higher rates of access to mental health providers than other states (Mental Health of America, 2015). Further, the sample size was small and survey response rate can only be estimated. These limitations may restrict the generalizability of the study's findings. However, provider demographics and PBS scores were comparable to other studies, thus indicating that the study's findings, despite the sampling restrictions, may be generalizable to the other populations of PCPs. Finally, the study relied on the use of survey methodology, which only assessed provider perceptions of potential impact of certain criteria on their selection and use of psychosocial interventions. The actual feasibility of intervention implementation in daily practice may differ from perceived feasibility and should also be assessed. Further, qualitative inquiry may provide a more in depth understanding of provider use of psychosocial interventions in pediatric primary care settings and should be used in future studies.

Future Directions and Implications

Although initiatives to train primary providers in this approach are promising (e.g., Stephan, Wissow, & Pichler, 2010), there is little known regarding the feasibility and acceptability of a modular treatment approach for use by PCPs, and the potential impact of such an approach has not been tested. Findings from this study could inform the adaptation of existing modular treatment approaches, as well as factors that may impact adoption of mental health treatment practices by PCPs. For example, treatment components that are brief, easy to learn and use, and applicable to a broad set of presenting problems may be most desirable when selecting a core set of mental health skills for PCPs. Given findings that negative PCP attitudes and beliefs toward addressing youth psychosocial concerns impact implementation of treatment components in primary care practice, future research may consider how to improve attitudes and beliefs as a precursor to training in actual modular treatment approaches. Beyond simply arming PCPs with mental health treatment practices, future work must also examine how to support PCPs in interpreting evidence and making decisions about which practices are best suited for which patients (Chorpita & Daleiden, 2014).

Notable challenges regarding the delivery of psychosocial interventions by PCPs continue to exist. Particularly salient among these are ethical concerns related to supporting the delivery of mental health care by PCPs, whose relevant training varies greatly (Stein et al., 2008) and who may not be appropriately prepared to deliver psychosocial interventions (Pidano, Kimmelblatt, & Neace, 2011). Nonetheless, PCPs are faced with a large number of youth who present with mental health concerns who may require intervention (Kessler & Stafford, 2008). As such, whether or not colocation is available, the role of PCPs in the larger role of mental health care has been underscored and PCPs have been encouraged to develop the skills to identify and address the needs of youth with mental health concerns presenting in their offices (American Academy of Pediatrics, 2009). Thus, despite the many challenges that exist with the delivery of certain psychosocial interventions by the PCP, efforts to support such integration and the delivery of high-quality psychosocial interventions by PCPs are needed. Findings from this study contribute knowledge to the initial steps of the larger effort of integrated behavioral health to address the mental health needs of youth.

http://dx.doi.org/10.1037/fsh00000233

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Received March 16, 2016

Revision received August 11, 2016

Accepted August 31, 2016

Prerna G. Arora, PhD

University of Maryland and Pace University

Sharon Hoover Stephan, PhD, and Kimberly D. Becker, PhD University of Maryland

Lawrence Wissow, MD

Johns Hopkins University

This article was published Online First November 10. 2016.

Prerna G. Arora. PhD, Division of Child and Adolescent Psychiatry, School of Medicine, University of Maryland, and Department of Psychology, Pace University; Sharon Hoover Stephan, PhD, and Kimberly D. Becker, PhD. Division of Child and Adolescent Psychiatry, School of Medicine. University of Maryland; Lawrence Wissow. MD, Department of Health, Behavior and Society, Bloomberg School of Public Health. Johns Hopkins University.

Funding for this work was provided by National Institutes of Health Grant P20 MH 086048. The contents of this article are the sole responsibility of the authors and do not represent the official position of the National Institutes of Health.

Correspondence concerning this article should be addressed to Prerna G. Arora. PhD, Division of Child and Adolescent Psychiatry, School of Medicine, University of Maryland, 737 West Lombard Street, 4th Floor, Baltimore. /MD 21201. E-mail: arorapm@gmail.com
Table 1
Physician and Practice Characteristics

Characteristic                                   n     %

Physician characteristics
  Gender
    Female                                      37    74%
    Male                                        12    26%
  Degree
    DO                                           2     4%
    MD                                          46    92%
    NP                                           1     2%
  Primary specialty (select all that apply)
    Family practice                              1     2%
    Pediatrics                                  49   100%
    Internal medicine                            1     2%
    Other: Developmental pediatrics              1     2%
    Other: Child psychiatry                      1     2%
  Specialty training
    Child behavior                              13    26%
    Child development                           12    24%
    Therapy                                      9    18%
    None                                        32    64%
  Time at current site
    Less than a year (1)                         4     8%
    1-4 years (2)                                8    16%
    5-9 years (3)                                8    16%
    10-14 years (4)                             10    20%
    15 or more years (5)                        19    38%
Practice characteristics
  Current organization
    HMO                                          0     0%
    FQHC/Public clinic                           8    16%
    Free-standing private practice              22    44%
    Hospital or hospital-owned ambulatory
      primary care facility                     17    34%
    Other                                        1     2%
  Practice structure
    Single specialty                            36    72%
    Multispecialty                              13    26%
  Colocated
    No                                          26    52%
    Yes                                         23    48%
  Location
    Rural                                        4     8%
    Suburban                                    21    42%
    Urban                                       24    48%
  Proportion of patients enrolled in Medicaid
    0-24%                                       19    38%
    25-49%                                       5    10%
    50-74%                                       6    12%
    75-100%                                     19    38%

Note. DO = Doctor of Osteopathy; MD = Doctor of Medicine;
NP = nurse practitioner; HMO = health maintenance
organization; FQHC = federally qualified health center.

Table 2
Primary Care Provider (PCP) Behavioral Health Intervention
Survey Categories and Items

Category                                     Item

Feasibility within      How much time the treatment will take for you
  the pediatric           to use in your visit
  primary care          How much the intervention will result in you
  setting                 uncovering potentially sensitive
                          information/in the patient disclosing a lot
                          of sensitive information
                        Whether the intervention will require multiple
                          follow-up visits with your patient Whether
                          you will need additional materials (e.g.
                          handouts, charts, etc....)
Training and            How easy the treatment is for you to use in
  comfort of the PCP      your visits
                        How easy the intervention is for you to learn
Patient and family      How applicable the intervention is to the
  characteristics         disorders that you see in your practice
                          (e.g. it can be used to help anxiety and
                          depression)
                        How applicable the intervention is to youth
                          across the developmental stages you see in
                          your practice
                        How applicable the intervention is to youth
                          and families from cultures you see in your
                          practice
                        How challenging the intervention will be for
                          the patient or caregiver to use after the
                          visit

Table 3 Criteria Rankings

Criteria                       Rank total   Rank 1   Rank 2   Rank 3

Time                              39         30        2        7
Applicable to multiple            24          4        7       12
  disorders
Ease of use                       19          8       10        1
Ease of learning                  16          1       12        3
Ease of parent/guardian           13          3        2        8
  implementation
Multiple visits                   10          1        5        4
Applicable to youth from          10          0        5        5
  diverse cultures
Applicable to across youth         5          0        2        3
  ages
Disclosure of sensitive            3          1        1        1
  information
Materials needed                   1          0        0        1
Other: Missing more serious        1          0        1        0
  conditions
Other: Reimbursement               1          0        0        1
Other: Ease of integration         1          0        0        1
  into EMR

Note. EMR = electronic medical record. Criteria added by
providers noted with label "Other."

Table 4
Correlation Matrix

Variable                                    1        2        3

PCP Behavioral Health Intervention
     Survey
   1. Time                                1
   2. Ease of use                         .68 **   1
   3. Disclosure of sensitive             .23      .21      1
      information
   4. Multiple visits                     .20      .06      .67 **
   5. Ease of learning                    .14      .20     -.03
   6. Applicable to multiple diagnoses    .13      .27      .14
   7. Applicable to across youth ages     .15      .21      .20
   8. Applicable to youth from diverse    .03      .09      .18
      cultures
   9. Materials                           .72      .03      .11
  10. Ease of parent/guardian             .23      .20      .20
      implementation
Demographic
  11. Ability                             .08      .07      .11
  12. Access referral                    -.19     -.09     -.19
  13. Reimbursement                      -.07     -.05      .02
Physician Belief Scale
  14. Burden                              .01     -.01      .26
  15. Belief                             -.19     -.16      .20

Variable                                    4        5        6

PCP Behavioral Health Intervention
     Survey
   1. Time
   2. Ease of use
   3. Disclosure of sensitive
      information
   4. Multiple visits                     1
   5. Ease of learning                   -.07       1
   6. Applicable to multiple diagnoses    .05       .38 **    1
   7. Applicable to across youth ages     .26       .28 *     .76 **
   8. Applicable to youth from diverse    .16       .23       .77 **
      cultures
   9. Materials                           .13      -.16       .38 **
  10. Ease of parent/guardian             .38 **    .26       .35 *
      implementation
Demographic
  11. Ability                             .05      -.27      -.15
  12. Access referral                    -.22      -.27      -.13
  13. Reimbursement                      -.03      -.15      -.08
Physician Belief Scale
  14. Burden                              .32 *     .29 *     .19
  15. Belief                              .33 *    -.07       .06

Variable                                    7        8         9

PCP Behavioral Health Intervention
     Survey
   1. Time
   2. Ease of use
   3. Disclosure of sensitive
      information
   4. Multiple visits
   5. Ease of learning
   6. Applicable to multiple diagnoses
   7. Applicable to across youth ages     1
   8. Applicable to youth from diverse    .77 **    1
      cultures
   9. Materials                           .31 *     .35 *     1
  10. Ease of parent/guardian             .33 *     .43 **    .31 *
      implementation
Demographic
  11. Ability                             .07      -.19       .09
  12. Access referral                    -.11      -.24      -.08
  13. Reimbursement                      -.15      -.13      -.54
Physician Belief Scale
  14. Burden                              .19       .23       .11
  15. Belief                              .09       .01       .12

Variable                                    10        11        12

PCP Behavioral Health Intervention
     Survey
   1. Time
   2. Ease of use
   3. Disclosure of sensitive
      information
   4. Multiple visits
   5. Ease of learning
   6. Applicable to multiple diagnoses
   7. Applicable to across youth ages
   8. Applicable to youth from diverse
      cultures
   9. Materials
  10. Ease of parent/guardian             1
      implementation
Demographic
  11. Ability                             -.14       1
  12. Access referral                     -.27       .02       1
  13. Reimbursement                       -.20       .19       .49 **
Physician Belief Scale
  14. Burden                              -.46 **   -.39 **   -.42 **
  15. Belief                              -.03      -.40 **    .01

Variable                                   13      14      15

PCP Behavioral Health Intervention
     Survey
   1. Time
   2. Ease of use
   3. Disclosure of sensitive
      information
   4. Multiple visits
   5. Ease of learning
   6. Applicable to multiple diagnoses
   7. Applicable to across youth ages
   8. Applicable to youth from diverse
      cultures
   9. Materials
  10. Ease of parent/guardian
      implementation
Demographic
  11. Ability
  12. Access referral
  13. Reimbursement                        1
Physician Belief Scale
  14. Burden                              -.21   1
  15. Belief                               .05   .38 **   1

Note. Measures included are PCP Behavioral Health
Intervention Survey and Physician Belief Scale.

* p < .05. ** p <.01.
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Article Details
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Author:Arora, Prerna G.; Stephan, Sharon Hoover; Becker, Kimberly D.; Wissow, Lawrence
Publication:Families, Systems & Health
Article Type:Survey
Geographic Code:1U5MD
Date:Dec 1, 2016
Words:6197
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