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Bringing Inclusion Into Pediatric Primary Health Care: A Systematic Review of the Behavioral Health Treatment of Racial and Ethnic Minority Youth

      Introduction

      Currently, pediatric behavioral health care accounts for one of the fastest growing health care expenditures. Children representing racial and ethnic minority groups are still found to experience significant behavioral health needs. Primary health care represents the first level of contact with the health care system.

      Method

      The purpose of this systematic review was to synthesize articles discussing the behavioral health needs and treatment of racial and ethnic minority in primary care settings.

      Results

      Results yielded 40 articles meeting the inclusion criteria. Themes included: provider screening, provider selected treatments, prevalence and need, and stigma and patient-provider communication.

      Conclusions

      Themes were discussed through the Ecological Systems Theory lens. Study limitations included its exclusion of intellectual disabilities like Autism Spectrum Disorder, lack of literature utilizing large minority samples, and lack of attention to the intersection between race and/or ethnicity alongside other demographics of concern like gender, age, social class, and geographical location.

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      References

        • Alegria M.
        • Vallas M.
        • Pumariega A.J.
        Racial and ethnic disparities in pediatric mental health.
        Child and Adolescent Psychiatric Clinics of North America. 2010; 19: 759-774
        • Amaral G.
        • Geierstanger S.
        • Soleimanpour S.
        • Brindis C.
        Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers.
        Journal of School Health. 2011; 81: 138-145
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders.
        5th ed. American Psychiatric Association, Arlington, VA2013
        • Angold A.
        • Erkanli A.
        • Copeland W.
        • Goodman R.
        • Fisher P.W.
        • Costello E.J.
        Psychiatric diagnostic interviews for children and adolescents: A comparative study.
        Journal of the American Academy of Child and Adolescent Psychiatry. 2012; 51: 506-517
        • Asarnow J.R.
        • Rozenman M.
        • Wiblin J.
        • Zeltzer L.
        Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis.
        JAMA Pediatrics. 2015; 169: 929-937
        • Bains R.M.
        • Franzen C.W.
        • White-Frese’ J
        Engaging African American and Latino adolescent males through school-based health centers.
        Journal of School Nursing. 2014; 30: 411-419
        • Bauer N.S.
        • Yoder R.
        • Carroll A.E.
        • Downs S.M.
        Racial/ethnic differences in the prevalence of anxiety using the Vanderbilt ADHD scale in a diverse community outpatient setting.
        Journal of Developmental and Behavioral Pediatrics. 2016; 37: 610-618
        • Beal A.C.
        Policies to reduce racial and ethnic disparities in child health and health care.
        Health Affairs. 23. 2004: 171-179
        • Begeer S.
        • Bouk S.E.
        • Boussaid W.
        • Terwogt M.M.
        • Koot H.M.
        Underdiagnosis and referral bias of autism in ethnic minorities.
        Journal of Autism and Developmental Disorders. 2009; 39: 142-148
        • Berge J.M.
        • Law D.D.
        • Johnson J.
        • Wells M.G.
        Effectiveness of a psychoeducational parenting group on child, parent, and family behavior: A pilot study in a family practice clinic with an underserved population.
        Families, Systems and Health. 2010; 28: 224-235
        • Blucker R.T.
        • Jackson D.
        • Gillaspy J.A.
        • Hale J.
        • Wolraich M.
        • Gillaspy S.R.
        Pediatric behavioral health screening in primary care: A preliminary analysis of the pediatric symptom checklist-17 with functional impairment items.
        Clinical Pediatrics. 2014; 53: 449-455
        • Bower P.
        • Garralda E.
        • Kramer T.
        • Harrington R.
        • Sibbald B.
        The treatment of child and adolescent mental health problems in primary care: A systematic review.
        Family Practice. 2001; 18: 373-382
        • Brietzke M.
        • Perreira K.
        Stress and coping: Latino youth coming of age in a new latino destination.
        Journal of Adolescent Research. 2017; 32: 407-432
        • Bronfenbrenner U.
        Toward an experimental ecology of human development.
        American Psychologist. 1977; 32: 513-531
        • Bronfenbrenner U.
        The ecology of human development: Experiments by nature and design.
        Harvard University Press, Cambridge, MA1979
        • Butler A.M.
        Shared decision-making, stigma, and child mental health functioning among families referred for primary care-located mental health services.
        Families, Systems and Health. 2014; 32: 116-121
        • Castro J.
        • Billick S.B.
        • Swank A.C.
        Utility of a new Spanish RQC and PSC in screening with CBCL validation.
        Psychiatric Quarterly. 2016; 87: 343-353
        • Champion J.D.
        • Young C.
        • Rew L.
        Substantiating the need for primary care-based sexual health promotion interventions for ethnic minority adolescent women experiencing health disparities.
        Journal of the American Association of Nurse Practitioners. 2016; 28: 487-492
        • Chandra A.
        • Scott M.M.
        • Jaycox L.H.
        • Meredith L.S.
        • Tanielian T.
        • Burnam A.
        Racial/ethnic differences in teen and parent perspectives toward depression treatment.
        Journal of Adolescent Health. 2009; 44: 546-553
        • CNN
        Flint water crisis fast facts.
        2021 (Retrieved from)
        • Collins M.H.
        • Kelch-Oliver K.
        • Johnson K.
        • Welkom J.
        • Kottke M.
        • Smith C.O.
        Clinically significant depressive symptoms in African American adolescent females in an urban reproductive health clinic.
        Journal of Clinical Psychology in Medical Settings. 2010; 17: 175-182
        • Cooper H.
        Research synthesis and meta-analysis: A step-by-step approach.
        5th ed. SAGE Publications, Los Angeles, CA2017
        • Cuthbertson C.A.
        • Newkirk C.
        • Ilardo J.
        • Loveridge S.
        • Skidmore M.
        Angry, scared, and unsure: Mental health consequences of contaminated water in Flint, Michigan.
        Journal of Urban Health. 2016; 93: 899-908
        • Dababnah S.
        • Shaia W.E.
        • Campion K.
        • Nichols H.M.
        We had to keep pushing”: Caregivers’ perspectives on autism screening and referral practices of black children in primary care.
        Intellectual and Developmental Disabilities. 2018; 56: 321-336
      1. Data USA. (n.d.). Data USA: Flint, MI. Retrieved from https://datausa.io/profile/geo/flint-mi/

        • DeFrino D.T.
        • Marko-Holguin M.
        • Cordel S.
        • Anker L.
        • Bansa M.
        • Van Voorhees B.
        Why should I tell my business?”: An emerging theory of coping and disclosure in teens.
        Research and Theory for Nursing Practice. 2016; 30: 124-142
        • Dempster R.
        • Davis D.W.
        • Faye Jones V.
        • Keating A.
        • Wildman B
        The role of stigma in parental help-seeking for perceived child behavior problems in urban, low-income African American parents.
        Journal of Clinical Psychology in Medical Settings. 2015; 22: 265-278
        • Fortenberry G.Z.
        • Reynolds P.
        • Burrer S.L.
        • Johnson-Lawrence V.
        • Wang A.
        • Schnall A.
        • Wolkin A.
        Assessment of behavioral health concerns in the community affected by the flint water crisis - Michigan (USA) 2016.
        Prehospital and Disaster Medicine. 2018; 33: 256-265
        • Garland A.F.
        • Taylor R.
        • Brookman-Frazee L.
        • Baker-Ericzen M.
        • Haine-Schlagel R.
        • Liu Y.H.
        • Wong S.
        Does patient race/ethnicity influence physician decision-making for diagnosis and treatment of childhood disruptive behavior problems?.
        Journal of Racial and Ethnic Health Disparities. 2015; 2: 219-230
        • Godoy L.
        • Mitchell S.J.
        • Shabazz K.
        • Wissow L.S.
        • Horn I.B.
        Which African American mothers disclose psychosocial issues to their pediatric providers?.
        Academic Pediatrics. 2014; 14: 382-389
        • Habeger A.D.
        • Venable V.M.
        Supporting families through the application of a rural pediatric integrated care model.
        Journal of Family Social Work. 2018; 21: 214-226
        • Heard-Garris N.J.
        • Roche J.
        • Carter P.
        • Abir M.
        • Walton M.
        • Zimmerman M.
        • Cunningham R.
        Voices from Flint: Community perceptions of the Flint water crisis.
        Journal of Urban Health. 2017; 94: 776-779
        • Hourigan S.E.
        • Southam-Gerow M.A.
        • Quinoy A.M.
        Emotional and behavior problems in an urban pediatric primary care setting.
        Child Psychiatry and Human Development. 2015; 46: 289-299
        • Kelly S.M.
        • Gryczynski J.
        • Mitchell S.G.
        • Kirk A.
        • O'Grady K.E.
        • Schwartz R.P.
        Concordance between DSM-5 and DSM-IV nicotine, alcohol, and cannabis use disorder diagnoses among pediatric patients.
        Drug and Alcohol Dependence. 2014; 140: 213-216
        • Kelly S.M.
        • O'Grady K.E.
        • Gryczynski J.
        • Mitchell S.G.
        • Kirk A.
        • Schwartz R.P
        The concurrent validity of the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale in adolescent patients in an urban federally qualified health center.
        Substance Abuse. 2017; 38: 382-388
        • Koshy A.J.
        • Mautone J.A.
        • Pendergast L.L.
        • Blum N.J.
        • Power T.J.
        Validation of the behavioral health checklist in diverse pediatric primary care settings.
        Journal of Developmental and Behavioral Pediatrics. 2016; 37: 132-139
        • Kruizinga I.
        • Jansen W.
        • Carter A.S.
        • Raat H.
        Evaluation of an early detection tool for social-emotional and behavioral problems in toddlers: The brief infant toddler social and emotional assessment - A cluster randomized trial.
        BMC Public Health. 2011; 11: 494
        • Larson J.
        • dosReis S.
        • Stewart M.
        • Kushner R.
        • Frosch E.
        • Solomon B.
        Barriers to mental health care for urban, lower income families referred from pediatric primary care.
        Administration and Policy in Mental Health. 2013; 40: 159-167
        • Lê Cook B.
        • Brown J.D.
        • Loder S.
        • Wissow L
        Acculturation differences in communicating information about child mental health between Latino parents and primary care providers.
        Journal of Immigrant and Minority Health. 2014; 16: 1093-1102
        • Leiner M.A.
        • Balcazar H.
        • Straus D.C.
        • Shirsat P.
        • Handal G.
        Screening Mexicans for psychosocial and behavioral problems during pediatric consultation.
        Revista de Investigacion Clinica. 2007; 59: 116-123
        • Liang J.
        • Matheson B.E.
        • Douglas J.M.
        Mental health diagnostic considerations in racial/ethnic minority youth.
        Journal of Child and Family Studies. 2016; 25: 1926-1940
        • Lim S.W.
        • Silver E.J.
        • Leo J.
        • Kusulas M.
        • Alderman E.M.
        • Racine A.D.
        Primary care providers as mental health counselors: Views from urban, minority adolescents.
        Journal of Health Care for the Poor and Underserved. 2016; 27: 1053-1063
        • Marie-Mitchell A.
        • Studer K.R.
        • O'Conner T.G
        How knowledge of adverse childhood experiences can help pediatricians prevent mental health problems.
        Families, Systems and Health. 2016; 34: 128-135
        • Mason M.J.
        • Sabo R.
        • Zaharakis N.M.
        Peer network counseling as brief treatment for urban adolescent heavy cannabis users.
        Journal of Studies on Alcohol and Drugs. 2017; 78: 152-157
        • Metzler C.
        • Off G.
        Hispanic population continues to rise in NC as white population trails.
        2018 (Retrieved from)
        • Michigan Department of Health & Human Services
        Assessment of behavioral health needs for Flint residents released to guide further response efforts.
        2016 (Retrieved from)
        • Minnesota Department of Health
        Minnesota refugee health report 2017.
        2017 (Retrieved from)
        • Molleda L.
        • Bahamon M.
        • St George S.M.
        • Perrino T.
        • Estrada Y.
        • Herrera D.C.
        • Prado G.
        Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care.
        Journal of Pediatric Health Care. 2017; 31: 350-361
        • Morley C.P.
        A vignette-based study of ADHD, race, and insurance status in primary care (Unpublished doctoral dissertation).
        Syracuse University, Syracuse, NY2009
        • Mufson L.
        • Rynn M.
        • Yanes-Lukin P.
        • Choo T.H.
        • Soren K.
        • Stewart E.
        • Wall M.
        Stepped care interpersonal psychotherapy treatment for depressed adolescents: A pilot study in pediatric clinics.
        Administration and Policy in Mental Health and Mental Health Services. 2018; 45: 417-431
        • Mufson L.
        • Yanes-Lukin P.
        • Anderson G.
        A pilot study of brief IPT-A delivered in primary care.
        General Hospital Psychiatry. 2015; 37: 481-484
        • Ngo V.K.
        • Asarnow J.R.
        • Lange J.
        • Jaycox L.H.
        • Rea M.M.
        • Landon C.
        • Miranda J.
        Outcomes for youths from racial-ethnic minority groups in a quality improvement intervention for depression treatment.
        Psychiatric Services. 2009; 60: 1357-1364
        • O'Brien D.
        • Harvey K.
        • Howse J.
        • Reardon T.
        • Creswell C.
        Barriers to managing child and adolescent mental health problems: A systematic review of primary care practitioners’ perceptions.
        British Journal of General Practice. 2016; 66: e693-e707
        • Ozer E.M.
        • Zahnd E.G.
        • Adams S.H.
        • Husting S.R.
        • Wibbelsman C.J.
        • Norman K.P.
        • Smiga S.M.
        Are adolescents being screened for emotional distress in primary care?.
        Journal of Adolescent Health. 2009; 44: 520-527
      2. Peterson, B. L., Lewandowski, L. A., & Chiodo, L. M. (2011). Relationships among trauma, nightmares, and quality of life in urban, African American adolescents. Western Journal of Nursing Research, 33, 1104–1105.

        • Power T.J.
        • Hughes C.L.
        • Helwig J.R.
        • Nissley-Tsiopinis J.
        • Mautone J.A.
        • Lavin H.J.
        Getting to first base: Promoting engagement in family–school intervention for children with ADHD in urban, primary care practice.
        School Mental Health. 2010; 2: 52-61
        • Ramos M.M.
        • Sebastian R.A.
        • Stumbo S.P.
        • McGrath J.
        • Fairbrother G.
        Measuring unmet needs for anticipatory guidance among adolescents at school-based health centers.
        Journal of Adolescent Health. 2017; 60: 720-726
        • Rausch J.
        • Hametz P.
        • Zuckerbrot R.
        • Rausch W.
        • Soren K.
        Screening for depression in urban Latino adolescents.
        Clinical Pediatrics. 2012; 51: 964-971
        • Richardson L.P.
        • McCarty C.A.
        • Radovic A.
        • Suleiman A.B.
        Research in the integration of behavioral health for adolescents and young adults in primary care settings: A systematic review.
        Journal of Adolescent Health. 2017; 60: 261-269
        • Scholer S.J.
        • Hudnut-Beumler J.
        • Mukherjee A.
        • Dietrich M.S.
        A brief intervention facilitates discussions about discipline in pediatric primary care.
        Clinical Pediatrics. 2015; 54: 732-737
        • Sekhar D.L.
        • Ba D.M.
        • Liu G.
        • Kraschnewski J.L.
        Major depressive disorder screening remains low even among privately insured adolescents.
        Journal of Pediatrics. 2019; 204: 203-207
        • Sibinga E.M.S.
        • Kerrigan D.
        • Stewart M.
        • Johnson K.
        • Magyari T.
        • Ellen J.M
        Mindfulness-based stress reduction for urban youth.
        Journal of Alternative and Complementary Medicine. 2011; 17: 213-218
        • Stepler R.
        • Lopez M.H.
        4. Ranking the Latino population in the states.
        2016 (Retrieved from)
        • Valleley R.J.
        • Romer N.
        • Kupzyk S.
        • Evans J.H.
        • Allen K.D.
        Behavioral health screening in pediatric primary care: A pilot study.
        Journal of Primary Care and Community Health. 2015; 6: 199-204
        • Villalba J.A.
        The impressions of school nurses and school counselors related to health disparities of Latina/o students in rural, emerging Latino communities.
        Hispanic Health Care International. 2011; 9: 32-40
        • Walton J.R.
        • Mautone J.A.
        • Nissley-Tsiopinis J.
        • Blum N.J.
        • Power T.J.
        Correlates of treatment engagement in an ADHD primary care-based intervention for urban families.
        Journal of Behavioral Health Services and Research. 2014; 41: 539-547
        • Watanabe-Galloway S.
        • Valleley R.
        • Rieke K.
        • Corley B.
        Behavioral health problems presented to integrated pediatric behavioral health clinics: Differences in urban and rural patients.
        Community Mental Health Journal. 2017; 53: 27-33
        • Webb M.J.
        • Kauer S.D.
        • Ozer E.M.
        • Haller D.M.
        • Sanci L.A.
        Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review.
        BMC Family Practice. 2016; 17: 104
        • Weitzman C.
        • Edmonds D.
        • Davagnino J.
        • Briggs-Gowan M.J.
        Young child socioemotional/behavioral problems and cumulative psychosocial risk.
        Infant Mental Health Journal. 2014; 35: 1-9
        • White J.
        • South J.
        Health together: How community resources can enhance clinical practice.
        British Journal of General Practice. 2012; 62: 454-455
        • Williams M.E.
        • Zamora I.
        • Akinsilo O.
        • Chen A.H.
        • Poulsen M.K.
        Broad developmental screening misses young children with social-emotional needs.
        Clinical Pediatrics. 2018; 57: 844-849
        • Wissow L.S.
        • Brown J.
        • Fothergill K.E.
        • Gadomski A.
        • Hacker K.
        • Salmon P.
        • Zelkowitz R.
        Universal mental health screening in pediatric primary care: A systematic review.
        Journal of the American Academy of Child and Adolescent Psychiatry. 2013; 52: 1134-1147.e23
        • Wren F.J.
        • Berg E.A.
        • Heiden L.A.
        • Kinnamon C.J.
        • Ohlson L.A.
        • Bridge J.A.
        • Bernal M.P.
        Childhood anxiety in a diverse primary care population: Parent-child reports, ethnicity and SCARED factor structure.
        Journal of the American Academy of Child and Adolescent Psychiatry. 2007; 46: 332-340
        • Yogman M.W.
        • Betjemann S.
        • Sagaser A.
        • Brecher L.
        Integrated behavioral health care in pediatric primary care: A quality improvement project.
        Clinical Pediatrics. 2018; 57: 461-470
        • Young N.D.
        • Takala C.R.
        Sequential screening to improve behavioral health needs detection in primary care.
        Journal of the American Academy of Child and Adolescent Psychiatry. 2018; 57: 603-609

      Biography

      Florence J. Lewis, Medical Family Therapy Doctoral Program Alumni, Human Development and Family Science, East Carolina University, Greenville, NC.

      Biography

      Damon Rappleyea, Associate Professor, Human Development and Family Science, East Carolina University, Greenville, NC.

      Biography

      Katharine Didericksen, Assistant Professor, Human Development and Family Science, East Carolina University, Greenville, NC.

      Biography

      Natalia Sira, Associate Professor, Human Development and Family Science, East Carolina University, Greenville, NC.

      Biography

      James Byrd, Associate Professor, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.

      Biography

      Annabel Buton, Alumni, East Carolina University, Greenville, NC.