New screening program to identify children with behavioral, emotional problems

A study published in the March 2011 Archives of Pediatrics and Adolescent Medicine shows that Massachusetts' new court-ordered mental health screening and intervention program led to more children being identified as behaviorally and emotionally at risk. The program is called the Children's Behavioral Health Initiative (CBHI).

The study, led by researchers from MassGeneral Hospital for Children (MGHfC), looked at Medicaid well-child visits that included behavioral screens from 2008-2009. They found that, under the new mandate, the number of screens completed in the state increased from 80,000 a year to 300,000 per year. The number of children with emotional/behavioral problems identified by the screens also more than tripled, from about 6,000 per year to more than 20,000 per year. A separate set of analyses showed that referrals for mental health evaluations for children with Medicaid also increased significantly in Massachusetts at this time.

The study's lead author, Karen Kuhlthau, PhD, of the MGHfC Center for Child and Adolescent Health Policy, says. "Increased screening is a first important step in assuring that children get the mental health services that they need."

Study co-author Michael Murphy, EdD, MGH Psychiatry, says, "Childhood psychosocial issues are among the most common and disabling conditions of children and adolescents, both in this country and in the rest of the world. Routine screening as a part of well-child care can enable pediatricians to recognize problems sooner and to provide help, preferably at an earlier point in time when intervention would be more effective and/or less costly."

This study primarily used the Pediatric Symptoms Checklist (PSC) as the mental health screening tool. Developed by the study's authors at Massachusetts General Hospital, the PSC is a 35-item questionnaire given to parents at their child's well-appointment visit. Parents check off NEVER, SOMETIMES, or OFTEN when asked questions pertaining to their child's' emotional and behavioral well being. Questions include whether a child "has school grades dropping," "gets hurt frequently" or "acts younger than children his or her age." The PSC can be easily scored to alert the pediatrician to a child's likely emotional difficulties.

The PSC has been used throughout the United States for more than two decades, and just this past week, it received national recognition when it won the endorsement of the National Quality Forum, a voluntary organization that advises the federal and state governments on the best ways to measure outcomes. With NQF endorsement, the PSC may be used to evaluate parts of the new US health care plan.

Additional co-authors of the Archives of Pediatrics and Adolescent Medicine report are Michael Jellinek, MD, chief of Psychiatry and Jeanne Van Cleave, MD, MassGeneral Hospital for Children; Gwyne White, Rutgers University; and Jack Simmons, PhD, Massachusetts Department of Health and Human Services. The costs of the study were paid for by a grant from The Fuss Family.