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Primary Care Clinicians’ Comfort Level With Childhood Mental Health Medications

Primary Care Clinicians’ Comfort Level With Childhood Mental Health Medications 1024 683 Shannon Caldwell
Young pediatrician examining a little African-American girl at hospital. Health care, people concept

A recent survey of primary care clinicians revealed opportunities to improve mental health care for kids.

Each year, 20% of children are diagnosed with a mental health condition, and an estimated $247 billion are spent on the treatment and management of childhood mental health concerns. As the demand for pediatric mental health services continues to grow across the country, workforce shortages make it increasingly difficult for families to access the psychiatric care they need. As a result, families are turning to their primary care clinicians as their preferred resource for mental health care.

Cody Hostutler, PhD

Cody Hostutler, PhD

“We know primary care clinicians are on the front lines when it comes to managing mental health concerns,” says Cody Hostutler, PhD, pediatric primary care psychologist at Nationwide Children’s Hospital. “That’s why we surveyed 148 primary care clinicians across 11 different health care systems in the United States. Our goal was to learn about the frequency and comfort level of providers in initiating, managing and discontinuing mental health medications in the primary care setting.”

The survey included questions around three common mental health conditions; attention deficit hyperactivity disorder (ADHD), anxiety/depression and sleep problems for three different age ranges; early childhood (0 to 5 years old), middle childhood (6 to 11 years old) and adolescence (12 to 18 years old).

The results show varying comfort levels based on condition and age, as well as a greater need for mental health support in primary care.

“Clinicians are still largely uncomfortable managing pediatric mental health medications,” explains Dr. Hostutler. “This is what we expected, and is likely caused by a number of barriers, including lack of training, limited time and perceived scope of practice.”

Other notable findings include:

  • Primary care clinicians are equally uncomfortable maintaining medications as starting them. This suggests that ongoing mental health support in the primary care setting may be more effective than a handoff from a specialist.
  • Primary care clinicians are most comfortable prescribing ADHD medications. However, 25% of clinicians still report discomfort prescribing ADHD medications for kids ages 6 and older.
  • Primary care clinicians in rural areas are slightly more comfortable managing behavioral health medications. This may be caused by limited access to specialists, forcing clinicians to manage more on their own.
  • Primary care clinicians who are earlier in their careers are slightly more comfortable managing mental health medications, which may point to improved mental health training in medical education.

To fill the gaps and provide support to clinicians, Nationwide Children’s offers a suite of free programs, such as BH-Tips, Project ECHO, the Behavioral Health Integration Program and the Behavioral Health Learning Library, to help clinicians grow their knowledge and consult with behavioral health specialists in real time.

“Our research shows that primary care clinicians who participate in these programs are significantly more knowledgeable, more comfortable, and we actually see them change how they’re managing mental health conditions within the practice, including how they prescribe medications.”

This article appeared in the 2025 Fall/Winter print issue. Download the issue here.

 

Reference:

Hostutler CA, Wolf N, Stallworth K, Herbst R, Hoffses KW, Pajek J, Curtis D, Mautone JA, Riley AR, Shahidullah JD. Primary care clinician perspectives on medication prescribing for child mental health concerns. Clinical Pediatrics (Phila). 2025 Oct;64(9):1264-1273.

Image credit: Adobe Stock (header); Nationwide Children’s (portrait)

About the author

As a senior strategist of population health marketing at Nationwide Children’s Hospital, Shannon combines her passions for writing and strategic communication, with her desire to give back and make a positive impact in the community. Shannon works with a variety of clients and service lines to achieve goals aligned with the hospital’s strategic plan, like School Health Services, Healthy Neighborhoods Healthy Families, Partners For Kids and Behavioral Health. She serves on the executive board for the Central Ohio PRSA Chapter and she is the recipient of the 2021 Rising Star Award. Shannon is a 2018 graduate (Cum Laude) of Ohio Northern University.

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