Pediatric Symptom Checklist Research Articles

Psychosocial functioning and self‐rated health in Japanese school‐aged children: A cross‐sectional study

Emotional and behavioral disorders in children are school-health concerns; however, Japanese screening tools for such disorders are not yet available. We examined the association between psychosocial functioning as measured by the Pediatric Symptom Checklist (PSC) and self-rated health within school settings. A cross-sectional study was conducted for 2513 fifth and eighth graders from all of the primary and secondary schools in Shunan City, Japan. The Japanese PSC had high internal consistency (Cronbach's α = 0.90) and a factor structure similar to that of the English PSC. When the cut-off values were set to ≥ 28 and ≥ 17, 4-9% and 20-39% of our respondents, respectively, reported high PSC scores. A multiple ordinal logistic regression analysis showed that the odds ratio of a positive PSC score (≥ 28) for poorer self-rated health among ratings of "very good," "good," "fair," and "poor" was 3.5 (95% confidence interval = 2.6-4.8). There was a clear association between psychosocial dysfunction identified by a PSC score ≥ 28 and poor self-rated health. We offer directions for further research on appropriate PSC cut-off values with Japanese samples.

The Baby Pediatric Symptom Checklist: Development and Initial Validation of a New Social/Emotional Screening Instrument for Very Young Children

ObjectiveTo develop and validate the Baby Pediatric Symptom Checklist (BPSC), a brief social/emotional screening instrument for children less than 18 months. The BPSC is modeled after the Pediatric Symptom Checklist (PSC) and is part of the Survey of Wellbeing of Young Children, a comprehensive, freely available screening instrument designed for use in pediatric primary care. MethodBPSC items were developed by a team of experts who reviewed existing assessment instruments and relevant research literature. Scale construction and initial validation were conducted with 205 families from pediatric primary care sites and 54 families from referral clinics. A replication sample of 146 additional families were enrolled from an independent set of primary care practices. ResultsExploratory factor analysis revealed 3 dimensions of the BPSC: irritability, inflexibility, and difficulty with routines. Factor structure was confirmed in the replication sample. Retest reliability and internal reliability were adequate (intraclass correlation coefficient >0.70) across subscales, with the exception of the “irritability” subscale’s internal reliability in the replication sample. Construct validity of the “irritability” and the “difficulty with routines” subscales is supported by correlations with the Parenting Stress Index and the Ages & Stages Questionnaire: Social/Emotional, but the “inflexibility” subscale seems to be distinct from performance on these instruments. Tests of differential item functioning revealed no significant effects for race/ethnicity, child gender, parent education, or family income. Age-based normative data were calculated for each subscale. ConclusionThe BPSC assesses 3 domains of behavior for very young children and shows promise as a social/emotional screening instrument for pediatric primary care.

P.2.a.013 Mood stabilisers in the treatment of personality disorders and comorbid depression

Individuals with phenylketonuria (PKU) treated early and continuously are reported to have psychiatric and executive function impairments. The feasibility of screening for psychiatric distress and executive function impairment in individuals with PKU was tested in 3 separate clinics in North America.Individuals were offered screening for psychiatric distress using the Pediatric Symptom Checklist, the PSC–Youth Report or the Brief Symptom Inventory and executive function impairment using the Behavior Rating Inventory of Executive Function. Gender, age and blood phenylalanine (Phe) concentrations obtained most recently and during the 2 years prior to screening were assessed.More than 90% of patients with PKU accepted the screening for psychiatric distress during their routine clinic visit. The screening took 15–20 min. 32% of patients screened positive for psychiatric distress and 19% for executive function impairment. More individuals > 18 years screened positive for psychiatric distress while a similar number screened positive for executive function impairment across age groups. Lower blood Phe levels correlated with negative screening for psychiatric distress. Patients positive for psychiatric distress had higher (p = 0.009) median and most recent blood Phe values (p = 0.05).Routine screening for psychiatric distress of patients with phenylketonuria could be easily implemented in current clinic structures. High incidences of positive screens reinforce the need for regular psychiatric assessments of individuals with PKU. Identification and referral to local mental health providers might help to improve the standard of care for individuals with PKU.

Psychosocial Difficulties in Children Referred to Pediatric Urology: A Closer Look

To assess rates of psychosocial difficulties in children seen in a pediatric urology clinic to determine whether all patients should be screened for psychosocial problems, and to use standardized measures to determine whether the severity of voiding dysfunction and/or enuresis in children is related to their degree of psychosocial difficulties. A retrospective chart review was conducted to collect the Pediatric Symptom Checklist from all children referred to an outpatient urology clinic over a 6-month period. In addition, scores from the child's Dysfunctional Voiding Scoring System were collected for patients referred for voiding dysfunction and/or enuresis. Caregivers of 600 children completed the Pediatric Symptom Checklist as part of their child's outpatient clinic paperwork. Overall, 15.2% of the patients met the clinical cut-off for significant psychosocial difficulties. However, children with voiding dysfunction and/or enuresis were at increased risk for these problems, with the severity of their psychosocial difficulties being related to the severity of their urologic condition. It is unnecessary to screen all pediatric urology patients, although those referred for voiding dysfunction and/or enuresis should be screened for psychosocial difficulties. Children at greatest risk for psychosocial problems were those who were male, had a high body mass index, had nocturnal enuresis, had an elevated Dysfunctional Voiding Scoring System score, and/or reported frequent episodes of wetting or soaking their underwear when they wet. Importantly, children appear to be most concerned with "wetness."

The Preschool Pediatric Symptom Checklist (PPSC): Development and Initial Validation of a New Social/Emotional Screening Instrument

ObjectiveThis article describes the development and initial validation of the Preschool Pediatric Symptom Checklist (PPSC), a social/emotional screening instrument for children 18 to 60 months of age. The PPSC was created as part of a comprehensive screening instrument designed for pediatric primary care and is modeled after the Pediatric Symptom Checklist. MethodItems for the PPSC were developed by a team of experts who reviewed existing assessment instruments and relevant research literature. Scale construction and initial validation (including factor analysis and tests of construct validity) were conducted with 292 families from pediatric primary care sites and 354 families from referral clinics. One hundred seventy-one additional families were recruited from primary care sites to obtain an independent replication sample. ResultsExploratory factor analysis revealed 4 dimensions of the PPSC: Externalizing, Internalizing, Attention Problems, and Parenting Challenges. These dimensions were incorporated into a bifactor model that displayed a strong general factor, thus supporting the use of a total score. The PPSC total score shows strong internal and retest reliability, and it identifies children who score in the clinical range of a longer, well-validated, and more comprehensive parent-report instrument (the Child Behavior Checklist), as well as children who are reported to have a range of behavioral diagnoses. Moreover, sensitivity and specificity with respect to these criteria were comparable to those of another well-accepted but longer screener, the Ages & Stages Questionnaire: Social/Emotional. Finally, results for the PPSC total scale remained consistent when replicated in an independent sample. ConclusionThe PPSC shows promise as a social/emotional screening instrument for use in pediatric primary care.

EHR Transition Disrupted Pediatric MH Screenings

Back to table of contents Previous article Next article Professional NewsFull AccessEHR Transition Disrupted Pediatric MH ScreeningsJonathan WolfeJonathan WolfeSearch for more papers by this authorPublished Online:6 Apr 2012https://doi.org/10.1176/pn.47.7.psychnews_47_7_10-bAbstractThe implementation of an electronic health record (EHR) system was associated with a significant decline in the rate of behavioral health screenings conducted at a large pediatric practice in Massachusetts, according to a new study published in the March Psychiatric Services.Karen Hacker, M.D., M.P.H., of Cambridge Health Alliance and the Institute for Community Health led a team of researchers from Seattle’s Group Health Research Institute and the Harvard Pilgrim Health Care Institute’s Department of Population Medicine in assessing the practice’s screening rates before, during, and after the transition from paper to EHR reporting. The system the practice adopted was the Epic-Care EMR system.The practice’s seven pediatricians serve a diverse population of approximately 6,000 patients, of whom an average 180 per month are eligible for behavioral health screenings. The researchers noted that 54 percent of the clinic’s patients are nonwhite, 40 percent are publicly insured or self-paying, and 31 percent are non-English speakers. Roughly one-third of the patient population is below age 5.The practice began conducting behavioral health screenings in December 2003 using the Pediatric Symptom Checklist (PSC) for children aged 4.9 to 16 and the PSC-Youth Report for children aged 14 to 18.Prior to implementation of the EHR system in March 2005, patients or their caregivers would fill out paper screening forms for discussion with and scoring by their pediatrician, who would subsequently complete the form and insert it into the patient’s medical record.In the first nine months of conducting screenings, which the researchers defined as the study’s baseline period, the rate of behavioral health screenings, though variable, rose from approximately 70 percent to 91 percent. During this time, nurse management staff enhanced the screening process by conducting previsit medical-record reviews and attaching paper screening forms to the charts of those patients they deemed eligible for screenings.The practice’s transition to the EHR system was preceded by six months of planning and preparations, with all staff members receiving 40 hours of off-site training. During this period—from October 2004 to March 2005—the pediatric clinic’s screening rates fell from about 84 percent to 64 percent.To help the clinicians adjust to the new system, patient visits were halved during the first week of implementation and reduced by 25 percent in the second week. Additionally, in-house trainers were available on site. Yet despite these measures, the conversion was associated with a further drop in screening rates, with only 50 percent of eligible patients screened during the first month of electronic record reporting.The screening process remained the same following implementation of the EHR system, but the physicians were now tasked with entering results from the paper screening into a field-driven electronic database. The researchers also noted that paper screening forms were no longer attached to patients’ medical records prior to their visits, making it more difficult for front-desk staff to quickly identify which patients needed behavioral screenings.Over a period of three years, and with medical assistants eventually assuming responsibility for the entry of screening data, the practice’s behavioral health screening rates slowly returned to near baseline levels, reaching 82 percent by April 2008.The study was supported in part by a grant through the Integrated Health and Behavioral Health Care for Children, Adolescents, and Their Families program administered by the Health Resources and Services Administration’s Maternal and Child Health Bureau. The Harvard Pilgrim Health Care Foundation, the National Institute of Mental Health, and the Health Maintenance Organization Mental Health Research Network also provided partial support, as did the Health Maintenance Organization Research Network Centers for Education and Research on Therapeutics.Harvard Catalyst and the Harvard Clinical and Translational Science Center provided additional consultative support for the study, while Harvard University and affiliated academic health care centers provided additional funding. “Impact of Electronic Health Record Transition on Behavioral Health Screening in a Large Pediatric Practice” is posted at http://ps.psychiatryonline.org/article.aspx?articleid=1028614. ISSUES NewArchived

Friends, fun, frustration and fantasy: Child motivations for video game play

Although a considerable amount of attention has examined potential positive and negative consequences of video game play in children, relatively little research has examined children’s motivations for using games. The current study hopes to address this gap in the literature by examining children’s motivations for video game play in a large sample of youth (n = 1254). Results indicated that video game use was common, and often a social activity. Social play was mainly predicted by motivations related to socialization, fun/challenge and current stress level. Preference for violent games was more common in males and predicted by fun/challenge motivations and beliefs such games could be cathartic for stress. Children with clinically elevated levels of depressive and ADHD symptoms did not play more games, or more violent games, but were more inclined to endorse catharsis motivations for video game use. Results from this study provide understanding of what motivates children to use games, and how the motivations of children with symptoms of psychosocial problems (as identified via subscales of the Pediatric Symptom Checklist) may differ from others.

Rapid psychosocial function screening test identified treatment failure in HIV+ African youth

Psychosocial dysfunction in older children and adolescents is common and may lead to nonadherence to HIV treatments. Poor adherence leads to HIV treatment failure and the development of resistant virus. In resource-limited settings where treatment options are typically limited to only one or two available lines of therapy, identification of individuals at highest risk of failure before failure occurs is of critical importance. Rapid screening tools for psychosocial dysfunction may allow for identification of those children and adolescents who are most likely to benefit from limited psychosocial support services targeted at preventing HIV treatment failure. The Pediatric Symptom Checklist (PSC) is used in high resource settings for rapid identification of at-risk youth. In 692 HIV-infected treated children (ages of 8–< 17 years) in Botswana, having a high score on the PSC was associated with having virologic failure (OR 1.7, 95% CI: 1.1–2.6). The PSC may be a useful screening tool in pediatric HIV.

Using brief clinician and parent measures to track outcomes in outpatient child psychiatry: longer term follow-up and comparative effectiveness.

This study explored the feasibility and validity of using brief clinician- and parent-rated measures routinely over 6 months in outpatient child psychiatry. All patients under 18 years of age seen for intake in the Child Psychiatry Clinic from 1 August 2007 through 31 July 2010 were eligible for inclusion in the study. Data were collected at intake for 1033 patients and at 3- and 6-month follow-up. ANOVA for repeated measures showed statistically significant improvements in total and subscale scores on all three measures (Brief Psychiatric Rating Scale for Children, Children's Global Assessment Scale, and Pediatric Symptom Checklist) at both second and third assessments. The fact that both broadband and narrowband scales showed significant improvements over the first 6 months of care establishes the possibility that these measures could be used in experimental designs studying comparative effectiveness.

Factor Analyses of the Pediatric Symptom Checklist-17 With African-American and Caucasian Pediatric Populations

To validate a three-factor model for the Pediatric Symptom Checklist-17 (PSC-17) and evaluate its diagnostic accuracy with African-American and Caucasian children with and without a chronic illness. Mothers of 723 youth diagnosed with either type I diabetes (n = 210) or sickle cell disease (n = 191) and a nonill peer group (n = 322) completed a demographic questionnaire, the PSC-17, and the Child Behavior Checklist (CBCL). Confirmatory factor analyses and tests of measurement invariance validated a three-factor structure for the PSC-17 with African-American and Caucasian youth with and without a chronic illness. Receiver operating characteristic curves revealed optimal cut-off scores that are similar to published reports. A three-factor solution was replicated for the PSC-17 with African-American and Caucasian children with and without a chronic illness. Cut-off scores for identifying children at risk for emotional/behavioral problems were evaluated using the CBCL as the gold standard and are discussed.

Validation of the Pediatric Symptom Checklist in HIV-infected Batswana

Objective: To determine the validity of the Pediatric Symptom Checklist (PSC), a brief measure of psychosocial health, for screening HIV+ Batswana children. Method: Setswana versions of the parent and child PSC were administered to 509 HIV+ Batswana children (age 8–16) and their parents/guardians. Test properties were evaluated and cut-off scores were derived using receiver operating characteristic curve analysis. Scores on the parent-completed PSC and the child-completed PSC-Y were compared to parental and clinic staff reports of concern about the child's psychosocial health and to scores on the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. Results: The Setswana PSC has high internal consistency (Cronbach's alpha 0.87 for the parent-completed version). Comparing PSC scores to parental reports of concern and child-reported depression symptoms, a cut-off score of 20 on the PSC and PSC-Y maximised the sensitivity and specificity. Conclusions: The PSC performed well in Setswana-speaking children and is a promising screening tool for paediatric psychosocial problems in busy clinical settings. Screening with the PSC may allow for early detection and treatment of psychosocial problems. This is likely to be of particular value for HIV+ children for whom HIV treatment non-adherence may result from untreated psychosocial dysfunction.

Mental health matters in elementary school: first-grade screening predicts fourth grade achievement test scores

The objective of the study was to evaluate whether mental health problems identified through screens administered in first grade are related to poorer academic achievement test scores in the fourth grade. The government of Chile uses brief teacher- and parent-completed measures [Teacher Observation of Classroom Adaptation-Revised (TOCA-RR) and Pediatric Symptom Checklist (PSC-Cl)] to screen for mental health problems in about one-fifth of the country's elementary schools. In fourth grade, students take the national achievement tests (SIMCE) of language, mathematics and science. This study examined whether mental health problems identified through either or both screens predicted achievement test scores after controlling for student and family risk factors. A total of 17,252 students had complete first grade teacher forms and these were matched with fourth grade SIMCE data for 11,185 students, 7,903 of whom also had complete parent form data from the first grade. Students at risk on either the TOCA-RR or the PSC-Cl or both performed significantly worse on all SIMCE subtests. Even after controlling for covariates and adjusting for missing data, students with mental health problems on one screen in first grade had fourth grade achievement scores that were 14-18 points (~1/3 SD) lower than students screened as not at risk. Students at risk on both screens had scores that were on average 33 points lower than students at risk on either screen. Mental health problems in first grade were one of the strongest predictors of lower achievement test scores 3 years later, supporting the premise that for children mental health matters in the real world.

Communicating bad news in pediatric practice and its impact on child behavior

Objective Communicating bad news is an important and difficult skill, particularly in the pediatric setting, as medical education typically offers little formal preparation for this task. This study aimed an attempt to develop two Arabic language questionnaires, one for parents to show the reactions experienced during disclosure of the diagnosis, and the second questionnaire for newly graduated physicians to assess their experiences and knowledge about breaking bad news. Methods Assessment of child behavior was carried out using a pediatric symptom checklist in children with chronic disease (diabetes and epilepsy). One hundred mothers who visited diabetic and neurology clinics in the children's hospital, Cairo University, and 50 junior physicians participated in this study. Results Seventy-five percent of children in this study had normal behavior, whereas 25% of children had internalizing behavior. Fifty percent of physicians did not know whether their hospital has guidelines for breaking bad news. Conclusion Forty-two percent of junior physicians had received recent training in breaking bad news. In addition, there is a growing interest to improve doctor–parents relationship and medical care in children with chronic disease.

Factor Structure of the Pediatric Symptom Checklist with a Pediatric Gastroenterology Sample

Pediatric gastrointestinal disorders are commonly experienced by youth and have been shown to be associated with increased rates of psychosocial difficulties. Aim of the current study was to extend development of the Pediatric Symptom Checklist (PSC), a brief parent-completed measure designed to assess children's behavioral and emotional functioning, by examining its factor structure in a pediatric gastroenterology sample. Parents of 176 children ages 4-16years visiting a pediatric gastroenterologist completed the PSC. The factor structure of the PSC was examined using principal component analysis. Parallel analysis was utilized to determine the number of factors to retain and indicated that three factors existed within the data. A principal component analysis with varimax rotation identified factors measuring internalizing, externalizing, and attention difficulties. The three factors that emerged on the PSC provide initial support for the utility of the PSC in pediatric gastroenterology clinics.

Serial Pediatric Symptom Checklist Screening in Children With Prenatal Drug Exposure

To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure. The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared with an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled. Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco prenatally and postnatally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes. Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.

Psychosocial Screening in Children With Wartime-Deployed Parents

Children of U.S. military families are exposed to unique challenges and stressors directly related to their parents' wartime deployments, potentially placing them at higher risk for psychosocial disruption. The objective of this study was to investigate the effects of parental wartime military deployment on psychosocial symptoms as measured by parent and youth self-report on the Pediatric Symptom Checklist. During annual physicals at a large military pediatric clinic, parents (216) and youth (198) were surveyed about emotional and behavioral difficulties and the current status of parental deployment. Parents reported more child psychosocial symptoms, and youth self reported more psychosocial symptoms if there was a currently deployed parent. Youth self-reports may be another way to identify psychosocial symptoms in at-risk military youth. These findings accentuate the importance of training providers who care for military youth to recognize and respond to their unique needs during parental deployment.

Psychometric evaluation of the Turkish version of the Pediatric Symptom Checklist‐17 for detecting psychosocial problems in low‐income children

To evaluate the usefulness of Pediatric Symptom Checklist-17 in identifying psychosocial problems in low-income, Turkish children. Epidemiological data indicate that 10-20% of children in primary care settings exhibit significant psychosocial problems. Early detection and treatment of these problems may lead to considerable health benefits. However, the brief and valid screening tool for children with psychosocial problems is not available in Turkey. Survey. A sample of 306 parents with children between 6-16 years of age who were attending primary schools in Istanbul was included. The psychometric properties of the scale were established by examining the content, convergent, discriminant, construct validity and internal consistency and stability. Receiver operating characteristic analysis was conducted to estimate the optimal cut-off score of scale using the Child Behaviour Checklist as the criterion standard. Convergent validity was supported, and discriminant validity suggested that the scale successfully discriminated among the normal, borderline and clinical range groups. Although, exploratory factor analysis extracted three factors, confirmatory factor analysis did not meet the criteria for good model fit. Internal consistency was found to be 0·81; test-retest reliability was found to be 0·72. The area under curve was found to be 0·91 and optimal cut-off score was found to be 12 (sensitivity: 0·81; specificity: 0·86) for clinical range psychopathology. The results provided an empirical support for extending the use of the Pediatric Symptom Checklist-17 in the primary care settings. The Turkish version of the Pediatric Symptom Checklist-17 showed an adequate reliability and validity for its use in low-income, Turkish children. Primary care providers can use the Pediatric Symptom Checklist-17 for early identification of childhood psychosocial problems in primary care settings. This easy-to-use tool can provide guidance to care providers for further assessment of children.

Trajectories of Symptom Reduction During Treatment for Behavior Problems in Pediatric Primary-Care Settings

We examined trajectories of symptom reduction during the course of on-site treatment for behavior problems in pediatric primary-care settings for a subset of children from a larger clinical trial. Participants (N=80) were children (ages 6-11) referred for treatment due to moderate elevations (≥75th percentile) on the externalizing subscale of the Pediatric Symptom Checklist (PSC-17). The sample was recruited from six pediatric practices in an urban setting. The treatment (Protocol for an Office-based Nurse-administered Intervention; PONI) was administered on-site by trained nurses over the course of 3-6months. Overall, symptom reduction from the first session to last session was moderate (ES=0.61) and gradual. Roughly two-thirds (72%) of symptom reduction took place over the first 8weeks of treatment. The average trajectory of symptom reduction was characterized by a negative slope that flattened over time, consistent with a quadratic growth model. Initial symptom severity predicted final symptom severity (r=.36, P<.01), even though patients with greater initial symptom severity remained in treatment for a significantly greater number of sessions (r=.24, P<.05). The implications of these findings for enhancing the efficiency and effectiveness of treatment are discussed.

Maternal, paternal, and family health-related quality of life in the context of pediatric inflammatory bowel disease

The primary aim of this study was to examine the associations of disease activity and adolescent adjustment with parent and family health-related quality of life (HRQoL) among families of youths with inflammatory bowel disease (IBD). A secondary aim was to compare maternal and paternal perceptions of parent and family functioning. Ninety-five primarily Caucasian families (92 mothers and 43 fathers) of youths with IBD ranging in age from 11 to 18 participated. Most adolescents were diagnosed with Crohn's disease and had been diagnosed with IBD for several years at the time of the study. Parents completed the PedsQL Family Impact Module, while youths completed the Pediatric Symptoms Checklist. Disease activity ratings were obtained from medical records. Multiple regression analyses suggested that disease activity was consistently associated with all father-reported outcomes and explained twice as much of the variance in father-reported parent and family HRQoL outcomes compared to mother-reported outcomes. In contrast, youth adjustment was consistently associated with all maternal outcomes but only one paternal outcome, and explained nearly twice as much variance in maternal-reported outcomes compared to paternal-reported outcomes. No significant differences between maternal and paternal reports of parent or family HRQoL were identified using independent samples t tests. Although mothers and fathers report similar individual and family HRQoL, the strength of associations between disease and youth adjustment factors with these outcomes differs somewhat by parent gender. Findings underscore the importance of examining maternal and paternal functioning separately and incorporating routine family assessment into the course of treatment.

The Prevalence of Emotional and Behavior Problems in Pediatric Primary Care Serving Rural Children

To examine the prevalence of parent-reported emotional and behavior problems in pediatric primary care clinics serving rural Appalachia using methods commensurate with studies of broader samples. Parents presenting to pediatric primary care clinics completed a rating scale (Pediatric Symptom Checklist) of psychosocial problems for their child. Approximately 21% of all rating scales were in the clinically significant range. Across all parents, 63% identified the child's physician as their most common source of help. In contrast, mental health professionals had been sought out by only 24% of the sample. These data replicate previous findings showing high rates of parent-rated psychosocial problems in pediatric primary care. Given the prevalence of these problems in primary care and parents' frequent help seeking in this setting, more research is needed on innovative approaches to integrated care in rural settings.