The increasing prevalence of mental illness in children requires that pediatricians improve detection of behavioral health (BH) problems to identify previously unidentified children and facilitate entry into mental health treatment. Yet, little is known about the impact of pediatric BH screening on health care utilization and psychotropic medication use. Expanding this knowledge is critical to informing the development of screening programs and assessing their cost effectiveness. Towards this end, this NIH-funded study between the Institute for Community Health and partners at the Group Health Research Institute, the Department of Population Medicine at Harvard Medical School, and the Johns Hopkins Bloomberg School of Public Health will explore the relationship between implementation of pediatric BH screening and the quantity and quality of BH and non-BH care use.
The specific aims of the study are:
- To evaluate the impact of BH screening at the well-child visit (6.5 to 16.5 year olds) on the quantity and quality of health care use (primary care, ambulatory, in-patient and emergency department BH and non-BH visits) and psychotropic medication use in the Cambridge Health Alliance (CHA) system and state-wide among Medicaid children and adolescents; and
- To determine the magnitude of racial/ethnic, age and socio-economic (SES) differences regarding the impact of BH screening on the quantity and quality of health care use (primary care, ambulatory, in-patient and emergency department BH and non-BH visits) and psychotropic medication in the same systems.
To achieve these aims, we propose an innovative, exploratory, population-based, longitudinal study using an interrupted time series (ITS) design to examine changes in population utilization rates of BH and non-BH health care after the implementation of BH screening in two environments: CHA-a local safety-net system-and statewide among Medicaid insured children.