Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Amy Damashek

Second Advisor

Dr. Scott Gaynor

Third Advisor

Dr. Galen Alessi

Fourth Advisor

Dr. Sheryl Lozowski-Sullivan


Pediatrics, pediatric primary care, behavior management, pediatric primary care providers, primary care providers, training


Childhood mental health disorders are a significant public health concern in the United States. It is estimated that every year 13 to 20% of children living in the United States experience a mental health disorder (National Research Council and Institute of Medicine, 2009). Despite the clear need for mental health care, less than half (45.6%) of children with one or more emotional, behavioral, or developmental conditions receive treatment from a mental health professional (The National Survey of Children's Health, 2007). There is growing evidence that integrating mental health services into pediatric primary care can result in increased treatment access as well as improved clinical outcomes and patient satisfaction (Cluxton-Keller et al., 2015; Ginsburg et al., 2016; Kolko et al., 2014). However, there is minimal research that examines the effects of training pediatric primary care providers to implement mental health interventions.

This study examined the effectiveness of a brief training program for pediatric primary care providers. The training included information on effective behavioral interventions for common childhood behavior problems. The present study examined whether providers’ knowledge of childhood behavior problems and interventions increased from pre- to post-training. The study also examined whether providers’ reported level of confidence in their ability to discuss behavior problems as well as provide behavior management interventions increased after participating in the training. Finally, the study tracked the frequency of childhood behavior problems and frequency of interventions used by providers throughout the study.

Data were collected from 14 pediatric primary care providers in Kalamazoo County. A pre/post-test design was utilized to measure potential changes in provider knowledge and confidence. Chart reviews of electronic medical records were conducted to collect data on the frequency of occurrence of behavior problems during office visits as well as the frequency of use of behavior management or other intervention strategies.

There was a significant increase in provider-reported knowledge and confidence from pre- to post-training. There were no significant changes in provider-reported frequency of behavior problems, nor frequency of interventions from pre- to post-training. Use of SmartPhrases (intervention tools in the electronic medical record) occurred at a very low rate.

This study provided some preliminary evidence that a brief training for pediatric primary care providers was associated with an increase in self-reported knowledge of behavioral health concerns as well as confidence in implementing interventions. However, results are limited and additional research with a larger sample size and a more rigorous design is needed.

Access Setting

Dissertation-Open Access