InvisALERT Solutions – ObservSMART

Early Identification of Childhood Disorders in Primary Care

Primary care providers are usually the first clinicians to identify behavioral health problems in children. Children with disruptive behavioral problems show symptoms during their primary care visits and their families rely on their primary providers for information, resources and support.

Currently, the Institute for Family Health, the largest federally qualified health center in New York State, is assisting in an evidence-based preventative program that provides family-centered group therapy to children with disruptive behavior problems and their families. This program called the 4Rs and 2Ss model establishes supportive outlets for these families while providing their children specialized mental health treatment. This intervention also prioritizes integration of health providers, pediatric mental health clinicians and family partners for sustaining the multiple family group structure.

The 4Rs and 2Ss model stands for Rules, Respectful Communication, Relationships, Responsibility and Stress and Social support. The family group dynamic creates cohesion, and support, while reducing negative parent-child exchanges, parental stress and disobedient behaviors in children before symptoms worsen (McSilver Institute for Poverty, Policy, and Research, 2013). The group goal is to produce a significantly greater impact on child outcomes over time relative to support, responsibilities and respectful communication.

Over the past year, the Institute has identified a 20% prevalence rate among our school age children who identify with conduct and behavior problems at our centers. Previously, during these primary care visits, a provider was unable to offer referrals to these patients. With the 4Rs and 2Ss model, the primary care provider can inform patients about this opportunity and refer the patient’s families to these groups. The provider can participate in their patients’ treatment while sending them and their families to groups managed by behavioral health providers at our centers.

Now, physicians can refer children to preventative treatment programs before behavioral disorders become more problematic. By engaging patients in primary care, we are changing the current delivery system before behavioral disorders develop into more serious diagnoses. The ability to identify children in primary care setting prior to the development of more serious mental health problems will be transformational in prevention efforts.

For more information about the Institute for Family Health visit us online at

Virna Little, PsyD, LCSW-r, MBA, CCM, SAP, is Senior Vice President Psychosocial Services/Community Affairs, at The Institute for Family Health. Jessica Neufeld, MPH, is Special Projects Coordinator at The Institute for Family Health.

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