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Taking Issue   |    
Improving the Quality of Care for Children: Let's Dance
Bonnie T. Zima, M.D., M.P.H.,
Psychiatric Services 2007; doi: 10.1176/appi.ps.58.5.591
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This issue features a special section on stigma related to children's mental health. Findings from the National Stigma Study-Children (NSS-C), the first nationally representative survey of public knowledge, attitudes, and beliefs related to child mental health, provide a "snapshot" of American public views. The survey indicates that the public perceives disturbingly high rates of overmedication and social stigma.

This landmark study is a key step in developing a better understanding of the cultural factors that encompass child mental health problems and their relationship to quality of care for children and their families. Findings from qualitative research by Susan dosReis, Ph.D., and colleagues, underscore NSS-C's assertion that "stigma attached to child and adolescent mental health problems is complex … and not easily inferred from sociodemographic characteristics." Recurring themes noted in interviews with parents revealed patterns in parents' coming to terms with caring for a child with attention-deficit hyperactivity disorder—patterns related to their conceptualization of the disorder.

These articles encourage us to value the attitudes, beliefs, concerns, and priorities of those for whom we strive to provide high-quality clinical care and to integrate them in operational definitions of "good care" in our research. For children, the perspectives of the caregivers are significant, because they are often the gatekeepers and their support is necessary for treatment adherence.

Lofty goals, however, stimulate humbling reflection. How can we better integrate advances in the social sciences to describe contextual factors that influence quality of care? How can we ensure that the values of parents and other caregivers are included in treatment guidelines and medication algorithms? How much weight should be assigned to parents' priorities and preferences in developing quality indicators, particularly those related to safety? How do we integrate the "voice" of parents in our definitions of good care for children, both in care processes and outcomes?

Striving to balance patients' values with research evidence and clinical acumen is not new. The need for balance is highlighted in national reports on the quality of care. Interpersonal skill often counterbalances technical care in conceptual models of quality of care. The consistency of the belief that this balance is integral to high-quality care is remarkable. Like a graceful waltz, in which the dancers are intricately in tune and it is not really clear who is leading whom, we too should continuously strive in partnership to improve the quality of care for children.

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