Increasing identification of psychosocial problems.

To the Editor. Drs Kelleher et al1 tackled a critical and neglected topic in their research on detection of psychosocial problems in primary care. Although the apparent increase in identification rates is encouraging, the study's research protocol undoubtedly influenced detection rates. Physicians in both 1979 and 1996 were given a list of diagnostic codes to consider at each visit. The list essentially functioned as a standardized reminder to consider psychosocial development at each visit. In the real world, only about 25% of providers use standardized tools for developmental or behavioral/emotional screening.2 Had the study included a control group, it is likely that far fewer children would have been identified. One chart review study showed that physicians failed to recognize psychosocial problems in 83% of children.3 Using similar methods, Palfrey et al4 found that clinicians did not …