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Riehm KE, Brignone E, Gallo JJ, Stuart EA, Mojtabai R. Emergency health services use and medically-treated suicidal behaviors following depression screening among adolescents: A longitudinal cohort study. Prev Med 2022; 161:107148. [PMID: 35803349 DOI: 10.1016/j.ypmed.2022.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/24/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
The primary goal of depression screening is to reduce adverse psychiatric outcomes, which may have downstream implications for reducing avoidable health services use. The objective of this study was to examine the association of depression screening with emergency health services use and medically-treated suicidal behaviors among adolescents in the U.S. This longitudinal cohort study used insurance claims data from 57,732 adolescents who had at least one well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression to similar adolescents who were not screened for depression during the well-visit. Outcomes were examined over two-year follow-up and included emergency department use and inpatient hospitalizations for depression-related reasons, mental health-related reasons, and any reason as well as medically-treated suicidal behaviors. Log-binomial regression models were used to examine associations between depression screening and each outcome in the matched sample. Heterogeneity of associations by sex was examined with interaction terms. Being screened for depression was not consistently associated with emergency department use (depression-related reasons: RR = 1.00, 95% CI = 0.76-1.30; mental health-related reasons: RR = 1.02, 95% CI = 0.80-1.29; any reason: RR = 0.96, 95% CI = 0.83-1.11), inpatient hospitalizations (depression-related reasons: RR = 1.05, 95% CI = 0.84-1.31; mental health-related reasons: RR = 1.16, 95% CI = 1.00-1.33; any reason: RR = 1.05, 95% CI = 0.99-1.12), or medically-treated suicidal behaviors (RR = 0.83, 95% CI = 0.51-1.36). Associations were similar in magnitude among male and female adolescents. The results of this study suggest that depression screening, as it is currently practiced in the U.S., may not deter avoidable health services use among adolescents.
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Affiliation(s)
- Kira E Riehm
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Emily Brignone
- Data Science Research and Development, Highmark Health, Pittsburgh, PA, USA
| | - Joseph J Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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2
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Riehm KE, Brignone E, Stuart EA, Gallo JJ, Mojtabai R. Diagnoses and Treatment After Depression Screening in Primary Care Among Youth. Am J Prev Med 2022; 62:511-518. [PMID: 34801332 PMCID: PMC8940608 DOI: 10.1016/j.amepre.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Depression screening is universally recommended for adolescents presenting in primary care settings in the U.S. However, little is known about how depression screening affects the likelihood of being diagnosed with a mental disorder or accessing mental health care over time. METHODS This longitudinal cohort study used insurance claims data from adolescents who attended a well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression with similar unscreened adolescents. Diagnoses and treatment uptake were examined over a 6-month follow-up and included depression diagnoses, mood-related diagnoses, antidepressant medications, any mental health medication, and psychotherapy. Heterogeneity of associations by sex was also examined. Analyses were conducted from December 2020 to June 2021. RESULTS The sample included 57,732 adolescents (mean age, 14.26 years; 48.9% female). Compared with adolescents who were not screened for depression, adolescents screened for depression were 30% more likely to be diagnosed with depression (risk ratio=1.30, 95% CI=1.11, 1.52) and 17% more likely to receive a mood-related diagnosis (risk ratio=1.17, 95% CI=1.08, 1.27) but were not more likely to be treated with an antidepressant medication (risk ratio=1.11, 95% CI=0.82, 1.51), any mental health medication (risk ratio=1.15, 95% CI=0.87, 1.53), or psychotherapy (risk ratio=1.13, 95% CI=0.98, 1.31). Associations were generally stronger among female adolescents. CONCLUSIONS Adolescents who were screened for depression during a well-visit were more likely to receive a diagnosis of depression or a mood-related disorder in the 6 months after screening. Future research should explore methods for increasing treatment uptake after screening.
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Affiliation(s)
- Kira E Riehm
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Emily Brignone
- Data Science Research and Development, Highmark Health, Pittsburgh, Pennsylvania
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Burke RE, Hoffman ND, Guy L, Bailey J, Silver EJ. Screening, Monitoring, and Referral to Treatment for Young Adolescents at an Urban School-Based Health Center. THE JOURNAL OF SCHOOL HEALTH 2021; 91:981-991. [PMID: 34647330 DOI: 10.1111/josh.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study describes the experience of implementing a screening, monitoring, and referral to treatment (SMARTT) initiative at an urban middle school school-based health center. METHODS Retrospective data were collected for adolescents screened with the Pediatric Symptom Checklist-17-Y. At-risk adolescents having unmet health needs were offered a mental health referral, and those that declined a mental health referral were offered a primary care monitoring (PCM) visit with the medical provider. Chi-square analyses were used to evaluate differences in screening and outcomes by age, sex, and race/ethnicity. RESULTS One out of four adolescents had a positive PSC-17-Y or negative screen with other identified concerns. Approximately half of these at-risk adolescents accepted a mental health referral, and 86% of those who declined agreed to the PCM visit. More than two-thirds of the PCM group did not need continued monitoring and support at follow-up, and 85.4% of youth who had a mental health assessment accepted mental health services. CONCLUSIONS The SMARTT initiative successfully demonstrated that co-located and integrated mental health services can enhance access and connection to mental health services for at-risk youth. In addition, PCM visits were found to be an effective option for youth who declined mental health referrals.
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Affiliation(s)
- Robert E Burke
- Nurse Practitioner, , Montefiore Health System, Montefiore School Health Program, 3380 Reservoir Oval, Bronx, NY 10467
| | - Neal D Hoffman
- Associate Professor of Pediatrics, , Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, 10467
| | - Laura Guy
- Supervisor/ Program Director, , Montefiore Health System, Montefiore School Health Program, 3380 Reservoir Oval, Bronx, NY, 10467
| | - Jodi Bailey
- Director of Quality and Performance Improvement, , NYC Department of Health and Mental Hygiene, Office of School Health, Adolescent Health Unit, 30-30 47th Avenue, Long Island City, NY, 11101
| | - Ellen Johnson Silver
- Research Professor of Pediatrics, , Division of Academic General Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 6B-24, Bronx, NY, 10461
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Murphy JM, Stepanian S, Riobueno-Naylor A, Holcomb JM, Haile H, Dutta A, Giuliano CP, Bernstein SC, Joseph B, Shui AM, Jellinek MS. Implementation of an Electronic Approach to Psychosocial Screening in a Network of Pediatric Practices. Acad Pediatr 2021; 21:702-709. [PMID: 33285307 DOI: 10.1016/j.acap.2020.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A network of 18 pediatric practice locations serving predominantly commercially insured patients implemented the electronic administration of the Pediatric Symptom Checklist-17 parent-report (PSC-17P) for all 5.50- to 17.99-year-old children seen for well child visits (WCVs) and wrote up the results as a quality improvement project. The current study investigated this screening over 2 years to assess its implementation and risk rates over time. METHODS Parents completed the PSC-17P electronically before the visit and the scored data were immediately available in the patient's chart. Using billing and screening data, the study tracked rates of overall and positive screening during the first-year baseline (4 months) and full implementation phases of the project in the first (8 months) and second (12 months) year. RESULTS A total of 35,237 patients completed a WCV in the first year. There was a significant improvement in PSC-17P screening rates from the first-year baseline (26.3%) to full implementation (89.3%; P < .001) phases. In the second year, a total of 40,969 patients completed a WCV and 77.9% (n = 31,901) were screened, including 18,024 patients with screens in both years. PSC-17P screening rates varied significantly across the 18 locations and rates of PSC-17P risk differed significantly by practice, insurance type, sex, and age. CONCLUSIONS The current study demonstrated the feasibility of routine psychosocial screening over 2 years using the electronically administered PSC-17P in a network of pediatric practices. This study also corroborated past reports that PSC-17 risk rates differed significantly by insurance type (Medicaid vs commercial), sex, and age group.
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Affiliation(s)
- J Michael Murphy
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (JM Murphy, MS Jellinek), Harvard Medical School, Boston, Mass.
| | - Salpi Stepanian
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass
| | - Alexa Riobueno-Naylor
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Juliana M Holcomb
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Haregnesh Haile
- Department of Psychology (H Haile), The Catholic University of America, Washington, DC
| | - Anamika Dutta
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Christopher P Giuliano
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass
| | - Shelly C Bernstein
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass; Department of Pediatrics (SC Bernstein, MS Jellinek), Harvard Medical School, Boston, Mass
| | | | - Amy M Shui
- Biostatistics Center (AM Shui), Massachusetts General Hospital, Boston, Mass
| | - Michael S Jellinek
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (JM Murphy, MS Jellinek), Harvard Medical School, Boston, Mass; Department of Pediatrics (SC Bernstein, MS Jellinek), Harvard Medical School, Boston, Mass
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Wissow LS, Platt R, Sarvet B. Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth. Acad Pediatr 2021; 21:401-407. [PMID: 32858263 PMCID: PMC7445486 DOI: 10.1016/j.acap.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Lawrence S Wissow
- University of Washington School of Medicine/Seattle Children's Hospital (LS Wissow), Seattle, Wash.
| | - Rheanna Platt
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine (R Platt), Baltimore, Md
| | - Barry Sarvet
- University of Massachusetts Medical School - Baystate (B Sarvet), Springfield, Mass
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6
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Arauz-Boudreau A, Riobueno-Naylor A, Haile H, Holcomb JM, Lucke CM, Joseph B, Jellinek MS, Murphy JM. How an Electronic Medical Record System Facilitates and Demonstrates Effective Psychosocial Screening in Pediatric Primary Care. Clin Pediatr (Phila) 2020; 59:154-162. [PMID: 31808350 DOI: 10.1177/0009922819892038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Using questionnaires, administrative claims, and chart review data, the current study explored the impact of using an electronic medical record system to administer, score, and store the Pediatric Symptom Checklist (PSC-17) during annual pediatric well-child visits. Within a sample of 1773 Medicaid-insured outpatients, the electronic system demonstrated that 90.5% of cases completed a PSC-17 screen electronically, billing codes indicating a screen was administered agreed with the existence of a questionnaire in the chart in 98.8% of cases, the classification of risk based on PSC-17 scores agreed with the classification of risk based on the Current Procedural Terminology code modifiers in 72.9% of cases, and 90.0% of clinicians' progress notes mentioned PSC-17 score in treatment planning. Using an electronic approach to psychosocial screening in pediatrics facilitated the use of screening information gathered during the clinical visit and allowed for enhanced tracking of outcomes and quality monitoring.
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Affiliation(s)
- Alexy Arauz-Boudreau
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Michael S Jellinek
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - J Michael Murphy
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Martel RM, Darragh ML, Lawrence AJ, Shepherd MJ, Wihongi T, Goodyear-Smith FA. YouthCHAT as a Primary Care E-Screening Tool for Mental Health Issues Among Te Tai Tokerau Youth: Protocol for a Co-Design Study. JMIR Res Protoc 2019; 8:e12108. [PMID: 30626568 PMCID: PMC6329425 DOI: 10.2196/12108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/13/2023] Open
Abstract
Background In New Zealand (NZ), 1 in 4 adolescents is affected by mental health issues (eg, depression and anxiety) and engages in risk behaviors (eg, harmful drinking and substance abuse), with rates among Māori youth being significantly higher. The majority of NZ secondary school students visit their local primary health care providers (PHPs) at least annually, yet most do not seek help for mental health and risk behavior (MHB) concerns. While youth think it acceptable to discuss sensitive issues during a consultation with their PHPs, unless problems are severe, such conversations are not initiated by PHPs. Early intervention for MHB concerns can prevent long-term health and well-being issues. However, this relies on the early identification of developing problems and youth being offered and accepting help. YouthCHAT is an electronic, multi-item screening tool developed in 2016 to assess MHB concerns among youth. YouthCHAT is completed before a consultation with the PHP, who can access a summary report straight away. A help question allows young people to identify issues that need addressing. A resource pack uses stepped care pathways to guide providers to use appropriate brief interventions. Objective This study aimed to explore the utility, feasibility, and acceptability of YouthCHAT when tailored for use with youth in primary care settings with large Māori populations. Objectives of the study are to evaluate the implementation of YouthCHAT in nurse-led youth clinics, school-based clinics, and general practice in Te Tai Tokerau (Northland, NZ); to develop a framework for the scaling up of YouthCHAT across further settings; to assess health provider and youth acceptability of the tool; to improve screening rates for mental health and help-seeking behavior; to enable early identification of emerging problems; and to improve brief intervention delivery. Methods Using a bicultural mixed-methods co-design approach, 3 phases over a 3-year period will provide an iterative evaluation of the utility, feasibility, and acceptability of YouthCHAT, aiming to create a framework for wider-scale rollout and implementation. Results Recruitment for the first phase began in September 2018. YouthCHAT was implemented at the first site in October 2018 and is expected to be at a further two sites in late January to early February 2019. The study is due for completion at the end of 2021. Conclusions YouthCHAT has potential as a user-friendly, time efficient, and culturally safe screening tool for early detection of MHB issues in NZ youth. The resource pack assists the clinician to provide appropriate interventions for emerging and developed youth mental health and lifestyle issues. Involving input from community providers, users, and stakeholders will ensure that modifiable elements of YouthCHAT are tailored to meet the health needs specific to each context and will have a positive influence on future mental, physical, and social outcomes for NZ youth. International Registered Report Identifier (IRRID) PRR1-10.2196/12108
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Affiliation(s)
- Rhiannon Mary Martel
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Margot Louise Darragh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Aniva Joanne Lawrence
- Manaia Health Primary Health Organisation, Whangarei, New Zealand.,Te Tai Tokerau Primary Health Organisation, Kerikeri, New Zealand
| | - Matthew John Shepherd
- Faculty of Education and Social Work, Department of Counselling, Human Services and Social Work, The University of Auckland, Auckland, New Zealand
| | | | - Felicity Anne Goodyear-Smith
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
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8
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Abstract
OBJECTIVE To implement comprehensive screening for child behavior and social determinants of health in an urban pediatric practice and explore rates of referrals and follow-up for positive screens. METHOD Quality improvement methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children, a child behavior and social screen, for all children aged 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N = 349) were reviewed to track referrals and follow-up for positive screens. A secondary analysis explored associations between reported parental concern for their child's behavior and both child behavior symptoms and social stressors. RESULTS Over 18 months, 2028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the convenience sample, 28% scored positive for a behavioral problem, and 25% reported at least 1 social stressor. Of those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and approximately 50% completed referrals to the clinic social worker. Further analysis indicated that referral and follow-up rates varied depending on whether the family identified child behavior or social issues. Logistic regression revealed that parental concern was independently associated with child behavior symptoms (p = 0.001) and social stressors (p = 0.002). CONCLUSION Implementing a comprehensive psychosocial screen is feasible in pediatric primary care and may help target referrals to address psychosocial health needs.
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9
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Caballero TM, DeCamp LR, Platt RE, Shah H, Johnson SB, Sibinga EMS, Polk S. Addressing the Mental Health Needs of Latino Children in Immigrant Families. Clin Pediatr (Phila) 2017; 56:648-658. [PMID: 27879297 DOI: 10.1177/0009922816679509] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Latino children in the United States, whether immigrants themselves or children in immigrant families, are at high risk for mental health disorders stemming from poverty, exposure to trauma, assimilation stressors, and discrimination. The timely identification and treatment of mental health disorders in Latino children are compromised by limited healthcare access and quality as well as the lack of routine mental health screening in pediatric primary care. Here we review Spanish-language validity and implementation studies of Bright Futures previsit mental health screening tools and models of care. We identify strengths and weaknesses in the literature and suggest tools for use in mental health care assessment, management, and treatment for Latino children in pediatric primary care. Pediatricians can improve care of Latino children through awareness of risk factors for mental health disorders, integration of evidence-based screening tools, and advocacy for culturally tailored mental health resources.
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Affiliation(s)
| | | | | | - Harita Shah
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Sarah Polk
- 1 Johns Hopkins University, Baltimore, MD, USA
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10
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Carpenter AL, Pincus DB, Perrin EC, Bair-Merritt MH, Mian ND. Early identification of anxiety disorders: The role of the pediatrician in primary care. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1275642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Donna B. Pincus
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Ellen C. Perrin
- Floating Hospital, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | | | - Nicholas D. Mian
- Department of Psychology, University of New Hampshire at Manchester, Manchester, NH
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11
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Jimenez N, Quistberg A, Vavilala MS, Jaffe KM, Rivara FP. Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury. Pediatrics 2017; 139:e20162462. [PMID: 28159872 PMCID: PMC5330397 DOI: 10.1542/peds.2016-2462] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mild traumatic brain injury injuries (mTBIs), including concussions, represent >2 million US pediatric emergency department visits annually. Post-mTBI mental health symptoms are prominent and often attributed to the mTBI. This study examined whether individuals seeking post-mTBI mental health care had previous mental health diagnoses or a new onset of such disorders, and determined if mental health care utilization differed by race/ethnicity. METHODS Retrospective cohort study, using the Medicaid Marketscan claims national dataset (2007-2012). Utilization of mental health services 1 year before and 1 year after mTBI was compared between children with and without mental health diagnoses before injury. Primary outcome was receipt of post-mTBI outpatient mental health care. RESULTS A total of 31 272 children 20 years or younger were included, 8577 (27%) with mental health diagnoses before their mTBI and 22 695 without one. After injury, children without previous mental health disorders increased mental health services utilization; however, most (86%) postinjury mental health care was received by children with previous mental health disorders. Having a mental health diagnosis pre-mTBI was the most important risk factor for receiving post-mTBI mental health care (odds ratio 7.93, 95% confidence interval 7.40-8.50). Hispanic children were less likely to receive post-mTBI mental health care. CONCLUSIONS mTBI was associated with increased utilization of mental health services but most of these services were received by children with previous mental health disorders. Our documentation of racial/ethnic disparities in mental health care utilization reemphasize the importance of providing individualized, culturally, and linguistically competent care to improve outcomes after mTBI for all children.
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Affiliation(s)
- Nathalia Jimenez
- Departments of Anesthesiology and Pain Medicine,
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Alex Quistberg
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Monica S Vavilala
- Departments of Anesthesiology and Pain Medicine
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
- Pediatrics
| | - Kenneth M Jaffe
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
- Rehabilitation Medicine, and
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
- Pediatrics
- Epidemiology, and
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12
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Hacker K, Penfold R, Arsenault LN, Zhang F, Soumerai SB, Wissow LS. The Impact of the Massachusetts Behavioral Health Child Screening Policy on Service Utilization. Psychiatr Serv 2017; 68:25-32. [PMID: 27582240 PMCID: PMC5205553 DOI: 10.1176/appi.ps.201500543] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In 2008, Massachusetts Medicaid implemented a pediatric behavioral health (BH) screening mandate. This study conducted a population-level, longitudinal policy analysis to determine the impact of the policy on ambulatory, emergency, and inpatient BH care in comparison with use of these services in California, where no similar policy exists. METHODS With Medicaid Analytic Extract (MAX) data, an interrupted time-series analysis with control series design was performed to assess changes in service utilization in the 18 months (January 2008-June 2009) after a BH screening policy was implemented in Massachusetts and to compare service utilization with California's. Outcomes included population rates of BH screening, BH-related outpatient visits, BH-related emergency department visits, BH-related hospitalizations, and psychotropic drug use. Medicaid-eligible children from January 1, 2006, to December 31, 2009, with at least ten months of Medicaid eligibility who were older than 4.5 years and younger than 18 years were included. RESULTS Compared with rates in California, Massachusetts rates of BH screening and BH-related outpatient visits rose significantly after Massachusetts implemented its screening policy. BH screening rose about 13 per 1,000 youths per month during the first nine months, and BH-related outpatient visits rose to about 4.5 per 1,000 youths per month (p<.001). Although BH-related emergency department visits, hospitalization and psychotropic drug use increased, there was no difference between the states in rate of increase. CONCLUSIONS The goal of BH screening is to identify previously unidentified children with BH issues and provide earlier treatment options. The short-term outcomes of the Massachusetts policy suggest that screening at preventive care visits led to more BH-related outpatient visits among vulnerable children.
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Affiliation(s)
- Karen Hacker
- Dr. Hacker is with the Allegheny County Health Department and with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr Arsenault is with the Institute for Community Health, Cambridge, Massachusetts, and Harvard Medical School, Boston. Dr. Zhang and Dr. Soumerai are with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Healthcare Institute, Boston. Dr. Wissow is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Robert Penfold
- Dr. Hacker is with the Allegheny County Health Department and with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr Arsenault is with the Institute for Community Health, Cambridge, Massachusetts, and Harvard Medical School, Boston. Dr. Zhang and Dr. Soumerai are with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Healthcare Institute, Boston. Dr. Wissow is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lisa N Arsenault
- Dr. Hacker is with the Allegheny County Health Department and with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr Arsenault is with the Institute for Community Health, Cambridge, Massachusetts, and Harvard Medical School, Boston. Dr. Zhang and Dr. Soumerai are with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Healthcare Institute, Boston. Dr. Wissow is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Fang Zhang
- Dr. Hacker is with the Allegheny County Health Department and with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr Arsenault is with the Institute for Community Health, Cambridge, Massachusetts, and Harvard Medical School, Boston. Dr. Zhang and Dr. Soumerai are with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Healthcare Institute, Boston. Dr. Wissow is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Stephen B Soumerai
- Dr. Hacker is with the Allegheny County Health Department and with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr Arsenault is with the Institute for Community Health, Cambridge, Massachusetts, and Harvard Medical School, Boston. Dr. Zhang and Dr. Soumerai are with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Healthcare Institute, Boston. Dr. Wissow is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lawrence S Wissow
- Dr. Hacker is with the Allegheny County Health Department and with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr Arsenault is with the Institute for Community Health, Cambridge, Massachusetts, and Harvard Medical School, Boston. Dr. Zhang and Dr. Soumerai are with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Healthcare Institute, Boston. Dr. Wissow is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
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Savageau JA, Keller D, Willis G, Muhr K, Aweh G, Simons J, Sherwood E. Behavioral Health Screening among Massachusetts Children Receiving Medicaid. J Pediatr 2016; 178:261-267. [PMID: 27546203 DOI: 10.1016/j.jpeds.2016.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/08/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Judith A Savageau
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA; Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
| | - David Keller
- Department of Pediatrics, University of Colorado, Denver, CO
| | - Georgianna Willis
- Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
| | - Kathleen Muhr
- Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
| | - Gideon Aweh
- Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
| | - Jack Simons
- Children's Behavioral Health Initiative, Massachusetts Executive Office of Health and Human Services, Boston, MA
| | - Emily Sherwood
- Children's Behavioral Health Initiative, Massachusetts Executive Office of Health and Human Services, Boston, MA
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Hacker KA, Penfold RB, Arsenault LN, Zhang F, Soumerai SB, Wissow LS. Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization. Psychiatr Serv 2015; 66:1141-8. [PMID: 26129994 PMCID: PMC4633707 DOI: 10.1176/appi.ps.201400315] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care. METHODS In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupted time-series study was conducted to determine the impact on behavioral health care utilization in the 30 months after model implementation compared with the 18 months prior. Specifically, the change in trends of ambulatory, emergency, and inpatient behavioral health utilization was examined. Utilization data for 11,223 children ages ≥4 years 9 months to <18 years 3 months seen from 2003 to 2008 contributed to the study. RESULTS In the 30 months after implementation of pediatric behavioral health screening and colocation, there was a 20.4% cumulative increase in specialty behavioral health visit rates (trend of .013% per month, p=.049) and a 67.7% cumulative increase in behavioral health primary care visit rates (trend of .019% per month, p<.001) compared with the expected rates predicted by the 18-month preintervention trend. In addition, behavioral health emergency department visit rates increased 245% compared with the expected rate (trend .01% per month, p=.002). CONCLUSIONS After the implementation of a behavioral health screening and colocation model, more children received behavioral health treatment. Contrary to expectations, behavioral health emergency department visits also increased. Further study is needed to determine whether this is an effect of how care was organized for children newly engaged in behavioral health care or a reflection of secular trends in behavioral health utilization or both.
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Affiliation(s)
- Karen A Hacker
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Robert B Penfold
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lisa N Arsenault
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Fang Zhang
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Stephen B Soumerai
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lawrence S Wissow
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
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