Rising rates of identification of attention-deficit/hyperactivity disorder1 and other mental health disorders,2 and increasing recognition of their long-term morbidity,3- 5 have underscored the importance of creating efficient and effective mechanisms of providing access to high-quality mental health care for all children. The primary care setting should be an appropriate setting for recognition of and early intervention in these issues because virtually all children see a primary care pediatrician frequently in their first 3 years of life and at least once per year thereafter.6 Unfortunately, this potential is rarely met due to inconsistencies in pediatricians' training and skills; the enormous requirements for identification, care, prevention, and documentation of the myriad child health problems that pediatricians are called on to manage7; and a fiscal environment that demands ever-shorter visits and ever-more documentation. For many physicians, identifying appropriate mental health referrals is a difficult and increasingly time-consuming task,8 underscoring the motivation to develop new models of care.9
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