Discussion
We found that a brief training for generalists in collaborative care increased the odds that children and youths with positive SDQ scores would receive mental health care when they came for routine medical visits but did not result in greater improvement of child Strengths and Difficulties Questionnaire scores (the primary outcome measurement). GPs in both study groups were trained to recognize child and youth mental health problems and did so similarly. But intervention GPs were more likely to say that they had counseled about child mental health problems, and parents seeing intervention GPs were more likely to say that the GP had discussed parent and some child psychosocial problems.We do not know why, despite this increased care, that training only seemed to improve child outcomes among GPs in child-predominant practices. Their counseling could have been more impactful if they were able to incorporate prior knowledge of children with what was taught in the training. The child-predominant GPs may also have had more positive attitudes toward caring for children and families and communicated this positivity to parents. Studies of GPs with special interests have found that their attitudes and confidence are, understandably, shaped by their prior experiences.Among the GPs overall, female gender and longer time in practice had opposite influences on child outcomes. We suspect that social change and emigration from LMICs could result in cohorts of GPs with divergent training and practice styles.