You've watched your child graduate high school or college. You expected them to start building their own life. Instead, they seem stuck or unmotivated. They're avoiding work, sleeping through the day, and seemingly unable to take steps forward.
Well Visits: Converting Mental Health Concerns Into Action
PEDIATRICIAN GUIDE
You're identifying the issues—here's how to get more families to follow through
In this article, you will learn
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Communication shifts that increase family follow-through rates
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A three-step follow-through formula before families leave your office
As a pediatrician or primary care physician, you identify mental health concerns, provide referral information, and expect families to follow through. But some don't. Research reveals the scope of the problem: Only 18% of children complete mental health visits within 180 days of primary care referral. It's no surprise, the practices with high follow-through rates help parents understand why specialized care matters and, how they can access that care. Clear communication is crucial when discussing referrals. When doctors frame concerns as solvable problems and address parental fears directly, families are far more likely to take action.
Communication shifts that support families
Effective communication helps families move from uncertainty to action. By reframing concerns as solvable, directly addressing parental fears, and clearly outlining next steps, pediatricians foster trust and collaboration. These shifts increase the likelihood that families will follow through with referrals, ensuring children get timely support.
Reframe the situation
Reframing the situation fosters partnership and hope, not blame or alarm. For practical techniques to guide these conversations, consider insights from Motivational Interviewing (MI).
Collaborative problem-solving
Shift from a diagnostic tone to a collaborative one: "You're seeing what I'm seeing. Let's figure out what's creating these challenges for your child."
Normalize mental health conversations
Normalize mental health conversations
Clinical language can feel overwhelming and stigmatizing. When you frame concerns as problem-solving opportunities or compare them to familiar medical situations, you’re helping to normalize the concept of mental and behavioral challenges.
Compare mental health support to other medical needs: "Attention problems are like a fever. We need to understand the underlying cause to determine appropriate treatment. Just like the root cause of a fever could be the common cold, an ear infection, or heatstroke, the root cause of attention difficulties could be anxiety, ADHD, or a learning difference. We need to figure out ‘the why’ to move forward.”
Use high-impact phrases
To foster engagement, start with the parent’s experience rather than your own clinical observations. This will help transform the perception from "The doctor thinks something's wrong" to "Let's solve this problem together."
"Early support makes the biggest difference."
"You know your child best. Trust what you're seeing."
Connect symptoms to daily impact
Parents may be more likely to act by connecting seemingly unrelated issues to their child’s daily life, creating a sense of urgency and relevance. Many parents don't naturally make connections between mental health concerns and daily problems. Illustrate that the goal of receiving mental health support is to alleviate what is impacting quality of life for the child and the family. Physicians are in a unique position to help them see patterns across home, school, and social environments.
"The worry your child is experiencing makes bedtime take two hours and causes stomach aches before school. I imagine that's exhausting for your whole family."
"When struggles show up in multiple areas of your child's life, a comprehensive evaluation can prevent you from running around between specialists who don't normally communicate. A whole-child assessment will examine all contributing factors simultaneously and lead to coordinated treatment rather than fragmented care."
"Help parents act on referrals by creating urgency, offering hope, and clearing away obstacles."
Address common barriers
Most parental resistance is about fear of the unknown. Directly address specific concerns like labels, timing, and permanence to remove any barrier to action. Provide evidence-based responses and keep a neutral tone, regardless of their reasons for resistance.
When parents say "This is just a phase."
Respond with, "Even though this is temporary, we can help your child get through it easier. What would it mean to cut this difficult time in half?"
When parents say "We'll wait and see."
Acknowledge their desire to see improvement, then emphasize that, "When children struggle in multiple areas, early support makes the biggest difference. What worries you most about getting an evaluation?"
For elementary-age children, emphasize the importance of summer evaluations: "Getting answers before the new school year helps teachers understand how to support [child] from day one."
When parents say "We don't want our child to be labeled."
Reassure parents that seeking a professional assessment does not necessarily mean their child will receive a diagnosis or require long-term therapy. Clarify that, "This isn't about labels. It's understanding how your child's brain works best so they can succeed."
When parents say "I need to check our insurance first."
Parents often express understandable concerns about coverage, which is constantly changing. Have a standard set of mental health providers you know take insurance and prepare your staff. Explain, "Most insurance plans cover mental health evaluations. The provider' we recommend will verify your benefits and explain any out-of-pocket costs upfront." Empower your staff to facilitate this initial step. Even better, ask the mental health providers to whom you refer patients to provide your office with a full list of their in-network insurance carriers.
When parents say "I will research therapists online and think about it."
Some parents want to research multiple providers extensively, unfortunately that often leads to inaction. You might say: "While you're welcome to research options, I specifically recommend [provider] because they provide thorough assessments that align with what your child needs. Starting with an evidence-based practice that treats the whole child is more important than finding someone you might see as the perfect fit."
Reassure parents that seeking a professional assessment does not necessarily mean their child will receive a diagnosis or require long-term therapy. Clarify that, "This isn't about labels. It's understanding how your child's brain works best so they can succeed."
When parents say "I need to check our insurance first."
Parents often express understandable concerns about coverage, which is constantly changing. Have a standard set of mental health providers you know take insurance and prepare your staff. Explain, "Most insurance plans cover mental health evaluations. The provider' we recommend will verify your benefits and explain any out-of-pocket costs upfront." Empower your staff to facilitate this initial step. Even better, ask the mental health providers to whom you refer patients to provide your office with a full list of their in-network insurance carriers.
When parents say "I will research therapists online and think about it."
Some parents want to research multiple providers extensively, unfortunately that often leads to inaction. You might say: "While you're welcome to research options, I specifically recommend [provider] because they provide thorough assessments that align with what your child needs. Starting with an evidence-based practice that treats the whole child is more important than finding someone you might see as the perfect fit."
"I have submitted your information to the mental health provider we recommend. Someone from their office will follow up with you on email to schedule an appointment."
Create a formula for follow-through
Create a system so that your practice can easily make a clear path forward for the family and minimize attrition. Make your expectations for follow-through known and provide the tools families need before they leave your office. If the parents are still on the fence when they leave your office, share this article about When and How to Seek Mental Health Care for Your Child or print out this flyer which addresses common concerns and help them take action.
Make the concern concrete
"The challenges we've discussed are affecting your child's confidence and your family's daily life. As a general rule, when sleep, school, and home all feel difficult and persist for more than three weeks, that's your signal that we need to dig deeper and find solutions."
Explain the process
"During the initial intake appointment, you will speak to someone at the provider's office about what your child is experiencing, their medical history, and your goals. After this initial visit, you can decide what assessments you’re interested in. Then you will be connected with the right providers depending on the needs of your child.” Emphasize that the first appointment is often just about gathering information, not a long-term commitment.
Set expectations with a follow-up
"I'm writing a reminder for my office to call you in three weeks to hear how the evaluation went and discuss how we can support the results together." Even better if your mental health provider has a more formalized process for submitting referrals: "I have submitted your information to the mental health provider we recommend. Someone from their office will follow up with you on email to schedule an appointment."
This personal commitment and expectation from their pediatrician significantly increases follow-through and demonstrates your ongoing partnership. When parents leave with concrete next steps and realistic expectations, they don't get lost between your recommendation and the specialist's office. The follow-up call ensures nothing falls through the cracks.
This personal commitment and expectation from their pediatrician significantly increases follow-through and demonstrates your ongoing partnership. When parents leave with concrete next steps and realistic expectations, they don't get lost between your recommendation and the specialist's office. The follow-up call ensures nothing falls through the cracks.
The bottom line
You're already identifying concerns effectively. The key to transforming those concerns into action is increasing the family’s urgency and hope, while systematically removing perceived barriers. This means not only highlighting the importance of addressing problems early, but also affirming parents’ ability to help their child succeed. Express optimism about the child’s potential for improvement and be specific about the positive changes that can result from timely intervention. In every conversation, frame next steps as both important and achievable—emphasizing that the sooner families act, the sooner their child and family will experience relief.
At the same time, take concrete steps to lower the threshold for action. Anticipate questions about scheduling, insurance, or stigma, and proactively provide answers and resources. Encourage parents by assuring them that support for their child—and for them—is available every step of the way. Offer to help them navigate any logistical challenges, connect them directly with providers, or understand their options. By combining a sense of hope and momentum with clear strategies to overcome common obstacles, you empower families to move from hesitation to action, increasing the likelihood that they will access the care their child needs.
At the same time, take concrete steps to lower the threshold for action. Anticipate questions about scheduling, insurance, or stigma, and proactively provide answers and resources. Encourage parents by assuring them that support for their child—and for them—is available every step of the way. Offer to help them navigate any logistical challenges, connect them directly with providers, or understand their options. By combining a sense of hope and momentum with clear strategies to overcome common obstacles, you empower families to move from hesitation to action, increasing the likelihood that they will access the care their child needs.
Dr. Nicole Garber
Dr. Nicole Garber is triple board-certified in General Psychiatry, Child & Adolescent Psychiatry, and Obesity Medicine; a certified Dialectical Behavior Therapy (DBT) therapist; and has advanced training in psychodynamic therapy, mentalization-based therapy, and Acceptance & Commitment Therapy (ACT). She is also a nationally recognized eating-disorder expert, developing the adolescent eating-disorder track at the Menninger Clinic, leading the pediatric and adolescent eating-disorder program at Rosewood Centers, and has served as Vice President of Psychiatric Services at Meadows Behavioral Health and Chief of Psychiatry at The Meadows Ranch. She is a Fellow of the American Psychiatric Association and lectures nationally on eating-disorder diagnosis and treatment, self-harm, and integrated care.
How can Blackbird help?
If you recognize your child may need support and are interested in exploring mental health services, click here to get started. To speak to a Care Navigator, call (484) 202-0751 or email us at info@blackbirdhealth.com.
