How Much Time?

How Much Time Should Pediatricians Spend Doing Psychosocial Assessments?

Ed. Note – I observed in my ten years in the Mass. AAP mental health task force that we rarely discussed the role of time in how we approach the psychosocial assessment of children and families. The October 2012 task force meeting provided such an opportunity.

The mental health task force recently allowed us consider the issue of how much time we might consider spending doing psychosocial assessments. This is timely matter to consider because many believe the PCMH may provide us with an opportunity to improve the emotional health of families.

When I met with the task force I was offered a brief time to discuss two such challenges. The first one took place long ago when I chose to schedule well child visits at 30 minute intervals. That had implications for how much I would earn from my practice. It turned out to be a good decision because of what it helped me learn from the families in my practice.

But what was the second challenge? As a member of this task force I observed we never discuss the role of time regarding our approach to the psychosocial assessment of children and families. I shared why I believe spending a little extra time is so important in doing good assessments.

I prepared for each member a group of supportive documents. If you examine them, you might conclude you could provide adequate time for your patients and reap benefits not achievable in the usual 15 to 20 minute visit. Consider the following:

  • The Boston Globe front page story from May 21, 1998
    “BCBS urges pediatricians to seek payment for talking with families.” A major turning point for us at the time of 1998 Mass. Chapter annual meeting.
  • Making Time Work For You, July 2002, from www.cehl.org
    “By listening to families tell their stories, we unearth family secrets, such as incest, child abuse, or alcoholism.
  • Narrative and Medicine – NEJM, April 4, 2008, by Dr. Rita Charon
    Is there an alternative to the pediatric symptom check list? This article suggests that parents sharing their stories may be such an alternative.
  • “A Tortured Inheritance” – A New York Times, op-ed, April 2, 2010
    This op-ed was written by the daughter of a parent who committed suicide. The importance of taking time to discuss such things.
  • Success Stories – pp. 30 -37 from the Follow-Up Survey of CEHL Participants, 2011
    To help parents become our allies we should consider inviting them back at least once. But what clues can we gain during the well child visit?
  • Executive summary, 18 months Follow-up survey for CEHL
    This report compiled responses 18-months after completing a 12-month course in psychosocial pediatrics showing they could maintain their skills.
  • MCPAP newsletter – August 2012 – “Managing Mental Health Issues”
    Time needn’t be a challenge dealing with mental health issues. Tips on how to do so. The key is to acquire the habit of picking up problems early.
  • “Well parent” services can complement “well child” visits
    An article in August 2012 “Pediatrics” illustrated how working with parenting educators can save pediatrics much time.
  • The Many Faces of Abuse
    This article in www.cehl.org, by Mary Byrne, reminds us that nurturing resilience could turn out to be our real goal.

Most pediatricians, if they do a psychosocial assessment, derive a maximum of 3 benefits including making a diagnosis, instituting treatment of brief counseling and medication, and/or making a referral to MCPAP.

In contrast, my colleagues and I take adequate time once to carry out a three generational assessment in our own practice. By doing so we could derive 20 distinct benefits, validating this on a number of occasions. See the article, “On Becoming a Course Leader” for additional details.

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I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center,  and the families of my medical practice. 

I hope you find this site useful and encourage any comments.

- Dr. Howard King, M.D.