Elsevier

The Journal of Pediatrics

Volume 178, November 2016, Pages 261-267
The Journal of Pediatrics

Original Articles
Behavioral Health Screening among Massachusetts Children Receiving Medicaid

https://doi.org/10.1016/j.jpeds.2016.07.029Get rights and content

Objective

To assess the impact of a Massachusetts Medicaid policy change (the Children's Behavioral Health Initiative; CBHI, which required and reimbursed behavioral health [BH] screening with standardized tools at well child visits and developed intensive home- and community-based BH services) on primary care practice examining the relationship of BH screening to subsequent BH service utilization.

Study design

Using a repeated cross-sectional design, our 2010 and 2012 Medicaid study populations each included 2000 children/adolescents under the age of 21 years. For each year, the population was randomly selected and stratified into 4 age groups, with 500 members selected per group. Two data sources were used: medical records and Medicaid claims.

Results

The CBHI had a large impact on formal BH screening and treatment utilization among children/adolescents enrolled in Medicaid. Screening increased substantially (73%: 2010; 74%: 2012) since the baseline/premandate period (2007) when only 4% of well child visits included a formal screen. BH utilization increased among those formally screened but decreased among those with informal assessments.

Conclusions

CBHI implementation transformed the relationship between primary care and BH services. Changes in regulation and payment resulted in widespread BH screening in Massachusetts primary care practices caring for children/adolescents on Medicaid.

Section snippets

Methods

A repeated cross-sectional design examined standardized screenings, screening results, referral rates, and service utilization. Our baseline study,35 using fiscal year (FY) 2007 data, guided the current study of 2 follow-up periods spanning the implementation of the CBHI: FYs 2010 (July 1, 2009-June 30, 2010) and 2012 (July 1, 2011-June 30, 2012). Similar to the baseline study, medical record data were obtained to assess screenings, screening results, and service referrals. We used MassHealth

Results

Baseline data collected in FY2007 (prepolicy mandate) indicated few providers used formal screening tools, although informal screening was common.35 Among those with formal screens, 11.8% received BH services, 87.5% of which were provided in the outpatient setting. Among those formally screening positive, 40.0% received BH services, all in the outpatient setting. Among those informally screened, 20.1% received BH services with 87.9% of services provided in the outpatient setting. Lastly, among

Discussion

BH screening practices and subsequent BH service utilization changed dramatically after the 2008 implementation of the CBHI. Child health providers in Massachusetts now routinely screen a majority of children/adolescents for BH conditions using standardized tools. BH service utilization during the 6-month period after a WCV dramatically increased compared with pre-CBHI baseline data, and the use of ED/inpatient BH services decreased substantially.35, 36 Although the increase in service

References (37)

  • J. Belelieu

    Rosie D. and mental health screening: a case study in providing mental health screening at the Medicaid EPSDT visit

    (2010)
  • T.W. Croghan et al.

    Integrating mental health treatment into the patient centered medical home

    (2010)
  • K. Kuhlthau et al.

    Increases in behavioral health screening in pediatric care for Massachusetts Medicaid patients

    Arch Pediatr Adolesc Med

    (2011)
  • N. Sand et al.

    Pediatricians' reported practices regarding developmental screening: do guidelines work? Do they help?

    Pediatrics

    (2005)
  • S.A. Reijneveld et al.

    Identification and management of psychosocial problems among toddlers in Dutch preventive child health care

    Arch Pediatr Adolesc Med

    (2004)
  • J.P. Guevara et al.

    Effectiveness of developmental screening in an urban setting

    Pediatrics

    (2013)
  • A. Schonwald et al.

    Routine developmental screening implemented in urban primary care settings: more evidence of feasibility and effectiveness

    Pediatrics

    (2009)
  • Cited by (5)

    Funded by the Massachusetts Executive Office of Health and Human Services, which approved this manuscript for submission to a peer-reviewed journal. The authors declare no conflicts of interest.

    Portions of the study were presented at the following meetings: Children's Mental Health Research and Policy Conference, Tampa, FL, March 2-6, 2014; Pediatric Academic Societies, Vancouver, BC, May 3-6, 2014; and AcademyHealth Annual Research Meeting, San Diego, CA, June 8-10, 2014.

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