Disagreement in Parent and Primary Care Provider Reports of Mental Health Counseling

OBJECTIVES. The goals were to examine disagreement in primary care provider and parent reports of mental health counseling and to determine whether disagreement was associated with provider, parent, youth, and visit characteristics. METHODS. Directly after 749 visits to 54 pediatric primary care providers in 16 practices, the parents of youths 5 to 16 years of age and the providers independently reported whether mental health counseling was provided. The parent also reported child mental health symptoms, the reason for the visit, and his or her attitudes about receiving treatment for child mental health problems in primary care. The provider reported confidence in his or her mental health treatment skills, burden and beliefs associated with treating mental health problems, and the accessibility of mental health specialists. RESULTS. Providers reported delivering counseling during 31.9% of visits (n = 239), whereas parents reported receiving counseling during only 11.4% of visits (n = 86). Parents did not report receiving counseling during 74.8% of the visits in which the provider reported delivering counseling; this was more common when the parent was seeking help for a mental health problem, when the provider reported greater burden associated with treating mental health problems, and when the youth had more mental health symptoms or was of other race/Hispanic. Provider report of counseling in the absence of parent report of counseling was less common when the provider had greater access to mental health specialists. CONCLUSIONS. Parents often did not report that the counseling delivered in primary care was mental health treatment. Counseling that is not perceived as mental health treatment may fail to meet parent expectations for care or fail to help parents identify mental health problems. Pediatrics 2008; 122: 1204-1211