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Author Affiliations: Department of Pediatrics, Harvard Medical School (Drs Kuhlthau and VanCleave), Center for Child and Adolescent Health Policy (Drs Kuhlthau and VanCleave) and Department of Psychiatry (Drs Jellinek and Murphy and Ms White), Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School (Drs Jellinek and Murphy), and Executive Office of Health and Human Services, State of Massachusetts (Dr Simons), Boston, and Newton Wellesley Hospital, Newton (Dr Jellinek); and Department of Psychology, Rutgers University, New Brunswick, New Jersey (Ms White).
Objective To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the state's new court-ordered screening and intervention program.
Design Retrospective review of the number of pediatric well-child visits, number of screens, and number of screens that identify risk for psychosocial problems from January 2008 (the month pediatric screening started) to March 2009. During the surrounding 1-year period, we also examined the number of claims with a behavioral health evaluation code.
Participants Massachusetts Medicaid–enrolled children.
Intervention Funded court-ordered mandate to screen for mental health during Medicaid well-child visits.
Outcome Measures Percentage of visits with a screen, percentage of screens identified at risk, and number of children seen for behavioral health evaluations.
Results Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period.
Conclusions The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.
Kuhlthau K, Jellinek M, White G, VanCleave J, Simons J, Murphy M. Increases in Behavioral Health Screening in Pediatric Care for Massachusetts Medicaid Patients. Arch Pediatr Adolesc Med. 2011;165(7):660–664. doi:10.1001/archpediatrics.2011.18
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