Table 4.

Representative quotes for changes in PCP attitudes and behavior following participation in Project TEACH.

Theme	Representative quotes
PCP attitudes (comfort and role)	And the program kind of convinced me to look at it more like asthma, you know. I diagnose regular asthma. I treat cases of asthma. If I can’t handle a case that’s incredibly complicated, I refer out. And the program has kind of managed to convince me that ADHD should be looked at in the same way, so partially because I feel more comfortable with the knowledge, but partially just ‘cause it’s kind of re-convinced me of what my role as a primary care doctor is. I think I’m much more comfortable with the medications… discussing the Black Box warning. I’m more comfortable pushing. I have a teenager right now, and then she says she doesn’t want medication, …I feel comfortable pushing for that. I feel more confident starting an initial treatment, following up with the child, adjusting the dosage while I’m waiting for the child to receive mental health evaluation by either a psychiatrist or counseling from a psychologist, because I always try to see if the problem can be helped with behavioral therapy first. But if the child’s problem is so acute that something has to be done in order to keep them functional, I feel, I guess, more able to make that decision and administer the drugs, and then bring them back and monitor the effectiveness. I am less afraid of high dosing of medications than I was and so more willing to push up the dose a little bit. I’m more confident about trying different medications for ADHD, depression and anxiety I feel more confident in my ability to help bridge somebody until they get mental health services.…
PCP behaviors with patients and peers	I think the main thing that it [TEACH] did is it got me to incorporate more psychiatric questioning into my routine pediatric work, rather than just waiting for families to raise issues. And that’s an interesting thing because, years ago, I did, and I found that I actually upset people by doing that. And I stopped because I had people who didn’t come back to see me because I would ask those questions, tough questions. But I guess the training and maybe the fact that I’m a little older now has helped me to do that questioning in a way that people aren’t finding invasive. Well, I think what’s changed is that in the past if parents would call about certain things I would be more likely to refer them out somewhere. And since I took the class I’m more willing to see the child myself and, you know, do most of the things on my own, rather than referring … out. More sensitivity to their [mental health problems] presence when it isn’t obvious on the face of it, not taking a simple, ‘I’m fine,’ or checklist ‘no’ to these questions. I would say I’m seeing two to three times as many visits for mental health problems as I used to, and much of that is follow-up. Much of that is continuing to see things myself and follow-up that I would have previously referred and then just assumed it was taken care of. Yeah, one of the practitioners the other day just had a child come in who was kind of off the wall oppositional, and her first thought was, ‘I gotta get this child in to see a psychiatrist.’ I said, ‘Well, it did sound like he needs to see one, but why don’t you do this and that and this. At least we can help him now so no one gets hurt at home.’ I feel much more confident just giving advice.… So it {TEACH} helped me bring the information back and became a conduit to disburse that within my own group, help establish some of the guidelines how to initiate evaluation. So disburse that information to my colleagues in the practice and then being the one in the practice, secondly, who has the largest of the group with mental health conditions in pediatrics.

Theme

Representative quotes

PCP attitudes (comfort and role)

And the program kind of convinced me to look at it more like asthma, you know. I diagnose regular asthma. I treat cases of asthma. If I can’t handle a case that’s incredibly complicated, I refer out. And the program has kind of managed to convince me that ADHD should be looked at in the same way, so partially because I feel more comfortable with the knowledge, but partially just ‘cause it’s kind of re-convinced me of what my role as a primary care doctor is.
I think I’m much more comfortable with the medications… discussing the Black Box warning. I’m more comfortable pushing. I have a teenager right now, and then she says she doesn’t want medication, …I feel comfortable pushing for that.
I feel more confident starting an initial treatment, following up with the child, adjusting the dosage while I’m waiting for the child to receive mental health evaluation by either a psychiatrist or counseling from a psychologist, because I always try to see if the problem can be helped with behavioral therapy first. But if the child’s problem is so acute that something has to be done in order to keep them functional, I feel, I guess, more able to make that decision and administer the drugs, and then bring them back and monitor the effectiveness.
I am less afraid of high dosing of medications than I was and so more willing to push up the dose a little bit. I’m more confident about trying different medications for ADHD, depression and anxiety
I feel more confident in my ability to help bridge somebody until they get mental health services.…

PCP behaviors with patients and peers

I think the main thing that it [TEACH] did is it got me to incorporate more psychiatric questioning into my routine pediatric work, rather than just waiting for families to raise issues. And that’s an interesting thing because, years ago, I did, and I found that I actually upset people by doing that. And I stopped because I had people who didn’t come back to see me because I would ask those questions, tough questions. But I guess the training and maybe the fact that I’m a little older now has helped me to do that questioning in a way that people aren’t finding invasive.
Well, I think what’s changed is that in the past if parents would call about certain things I would be more likely to refer them out somewhere. And since I took the class I’m more willing to see the child myself and, you know, do most of the things on my own, rather than referring … out.
More sensitivity to their [mental health problems] presence when it isn’t obvious on the face of it, not taking a simple, ‘I’m fine,’ or checklist ‘no’ to these questions.
I would say I’m seeing two to three times as many visits for mental health problems as I used to, and much of that is follow-up. Much of that is continuing to see things myself and follow-up that I would have previously referred and then just assumed it was taken care of.
Yeah, one of the practitioners the other day just had a child come in who was kind of off the wall oppositional, and her first thought was, ‘I gotta get this child in to see a psychiatrist.’ I said, ‘Well, it did sound like he needs to see one, but why don’t you do this and that and this. At least we can help him now so no one gets hurt at home.’ I feel much more confident just giving advice.…
So it {TEACH} helped me bring the information back and became a conduit to disburse that within my own group, help establish some of the guidelines how to initiate evaluation. So disburse that information to my colleagues in the practice and then being the one in the practice, secondly, who has the largest of the group with mental health conditions in pediatrics.