Karen Hacker1, Lisa Arsenault2, Idalid Franco3, Deepika Shaligram4, Mardoche Sidor4, Mark Olfson5, Joel Goldstein4. 1. Institute for Community Health, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts; Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts. Electronic address: Khacker@challiance.org. 2. Institute for Community Health, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts. 3. Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts. 4. Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts. 5. Department of Psychiatry, Columbia University Medical Center, New York, New York.
Abstract
PURPOSE: Although mental health screening is recommended for adolescents, little is known about the predictors of referral to mental health services or engagement in treatment. We examined predictors of mental health referral from primary care and service use for commercially insured youth who had been screened using the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist. METHODS: A retrospective chart review was conducted of commercially insured patients 14-17 years of age who were newly identified by the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist at a well-child visit. Comparisons were made with propensity-matched negative adolescents meeting the same criteria. Bivariate analyses were conducted to examine differences between positives and negatives and between referred and nonreferred positives. Logistic regression analyses were performed to assess predictors of mental health referral for positive youth. RESULTS: Medical records of 117 positive and 110 negative youth were examined. Compared with negative youth, positive youth were significantly more likely to be referred for mental health treatment (p < .0001) and receive specialty mental health services (p < .0001). Of the positives, 54% were referred for mental health care and 67% of them accepted. However, only 18% completed a face-to-face mental health visit in the next 180 days. Pediatric Symptom Checklist score (odds ratio, 1.21; confidence interval, 1.03-1.42), parental or personal concern (odds ratio, 10.87; confidence interval, 2.70-43.76), and having depressive symptoms (odds ratio, 9.18; confidence interval, 1.49-56.60) were predictive of referral. CONCLUSIONS: Despite identification after behavioral health screening, limited treatment engagement by referred patients persists. Primary care physicians and mental health specialists must enhance their efforts to engage and monitor identified patients.
PURPOSE: Although mental health screening is recommended for adolescents, little is known about the predictors of referral to mental health services or engagement in treatment. We examined predictors of mental health referral from primary care and service use for commercially insured youth who had been screened using the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist. METHODS: A retrospective chart review was conducted of commercially insured patients 14-17 years of age who were newly identified by the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist at a well-child visit. Comparisons were made with propensity-matched negative adolescents meeting the same criteria. Bivariate analyses were conducted to examine differences between positives and negatives and between referred and nonreferred positives. Logistic regression analyses were performed to assess predictors of mental health referral for positive youth. RESULTS: Medical records of 117 positive and 110 negative youth were examined. Compared with negative youth, positive youth were significantly more likely to be referred for mental health treatment (p < .0001) and receive specialty mental health services (p < .0001). Of the positives, 54% were referred for mental health care and 67% of them accepted. However, only 18% completed a face-to-face mental health visit in the next 180 days. Pediatric Symptom Checklist score (odds ratio, 1.21; confidence interval, 1.03-1.42), parental or personal concern (odds ratio, 10.87; confidence interval, 2.70-43.76), and having depressive symptoms (odds ratio, 9.18; confidence interval, 1.49-56.60) were predictive of referral. CONCLUSIONS: Despite identification after behavioral health screening, limited treatment engagement by referred patients persists. Primary care physicians and mental health specialists must enhance their efforts to engage and monitor identified patients.
Authors: Wenna Xi; Samprit Banerjee; Robert B Penfold; Gregory E Simon; George S Alexopoulos; Jyotishman Pathak Journal: Gen Hosp Psychiatry Date: 2020-10-07 Impact factor: 3.238
Authors: Karen Hacker; Robert Penfold; Lisa N Arsenault; Fang Zhang; Stephen B Soumerai; Lawrence S Wissow Journal: Psychiatr Serv Date: 2016-09-01 Impact factor: 3.084
Authors: Iro Fragkaki; Maaike Cima; Maaike Verhagen; Dominique F Maciejewski; Marco P Boks; Pol A C van Lier; Hans M Koot; Susan J T Branje; Wim H J Meeus Journal: J Youth Adolesc Date: 2018-10-12
Authors: Ana Radovic; Kerry Reynolds; Heather L McCauley; Gina S Sucato; Bradley D Stein; Elizabeth Miller Journal: J Pediatr Date: 2015-07-02 Impact factor: 4.406
Authors: Karen A Hacker; Robert B Penfold; Lisa N Arsenault; Fang Zhang; Stephen B Soumerai; Lawrence S Wissow Journal: Psychiatr Serv Date: 2015-07-01 Impact factor: 3.084
Authors: Amit Shapira; Lisa K Volkening; Jessica T Markowitz; Deborah A Butler; Lori M Laffel Journal: Pediatr Diabetes Date: 2020-11-04 Impact factor: 4.866