Pediatricians may address barriers inadequately when referring low-income preschool-aged children to behavioral health services.

BACKGROUND Low-income parents often seek help from pediatricians for early childhood social-emotional problems but seldom follow through with referrals to behavioral health services. OBJECTIVE We sought to understand low-income parents' experiences seeking help from pediatricians for social-emotional problems and how those experiences influenced decisions about accessing behavioral health services. METHODS We conducted 20 semi-structured interviews with low-income parents with concerns about their children's behavior or emotions. Participants were asked about experiences seeking help from pediatricians and decision-making about accessing behavioral health services. RESULTS Three themes emerged: (1) Participants described reluctance to recognize social-emotional problems, which was often reinforced by doctors' reassurance. (2) Participants reported pediatricians did not meet their expectations about testing, providing explanations/advice, or addressing behavior on-site. (3) Participants had unclear expectations of behavioral health services. CONCLUSIONS Primary care mechanisms that reliably educate parents about behavioral trajectories and the role of behavioral health providers may improve follow-up rates.