Karen A Hacker1, Robert B Penfold2, Lisa N Arsenault3, Fang Zhang4, Michael Murphy5, Lawrence S Wissow6. 1. Allegheny County Health Department, and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; khacker@ACHD.net. 2. Group Health Research Institute, and Department of Health Services Research, University of Washington, Seattle, Washington; 3. Institute for Community Health, Cambridge Health Alliance. 4. Harvard Pilgrim Healthcare Institute, Department of Population Medicine, and. 5. Massachusetts General Department of Child Psychiatry, Harvard Medical School, Boston, Massachusetts; and. 6. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
OBJECTIVES: To determine the relationship of child behavioral health (BH) screening results to receipt of BH services in Massachusetts Medicaid (MassHealth) children. METHODS: After a court decision, Massachusetts primary care providers were mandated to conduct BH screening at well-child visits and use a Current Procedural Terminology code along with a modifier indicating whether a BH need was identified. Using MassHealth claims data, a cohort of continuously enrolled (July 2007-June 2010) children was constructed. The salient visit (first use of the modifier, screening code, or claim in fiscal year 2009) was considered a reference point to examine BH history and postscreening BH services. Bivariate and multivariate logistic regression analyses were performed to determine predictors of postscreening BH services. RESULTS: Of 261,160 children in the cohort, 45% (118,464) were screened and 37% had modifiers. Fifty-seven percent of children screening positive received postscreening BH services compared with 22% of children screening negative. However, only 30% of newly identified children received BH services. The strongest predictors of postscreening BH services for children without a BH history were being in foster care (odds ratio, 10.38; 95% confidence interval, 9.22-11.68) and having a positive modifier (odds ratio, 3.79; 95% confidence interval, 3.53-4.06). CONCLUSIONS: Previous BH history, a positive modifier, and foster care predicted postscreening BH services. Only one-third of newly identified children received services. Thus although screening is associated with an increase in BH recognition, it may be insufficient to improve care. Additional strategies may be needed to enhance engagement in BH services.
OBJECTIVES: To determine the relationship of child behavioral health (BH) screening results to receipt of BH services in Massachusetts Medicaid (MassHealth) children. METHODS: After a court decision, Massachusetts primary care providers were mandated to conduct BH screening at well-child visits and use a Current Procedural Terminology code along with a modifier indicating whether a BH need was identified. Using MassHealth claims data, a cohort of continuously enrolled (July 2007-June 2010) children was constructed. The salient visit (first use of the modifier, screening code, or claim in fiscal year 2009) was considered a reference point to examine BH history and postscreening BH services. Bivariate and multivariate logistic regression analyses were performed to determine predictors of postscreening BH services. RESULTS: Of 261,160 children in the cohort, 45% (118,464) were screened and 37% had modifiers. Fifty-seven percent of children screening positive received postscreening BH services compared with 22% of children screening negative. However, only 30% of newly identified children received BH services. The strongest predictors of postscreening BH services for children without a BH history were being in foster care (odds ratio, 10.38; 95% confidence interval, 9.22-11.68) and having a positive modifier (odds ratio, 3.79; 95% confidence interval, 3.53-4.06). CONCLUSIONS: Previous BH history, a positive modifier, and foster care predicted postscreening BH services. Only one-third of newly identified children received services. Thus although screening is associated with an increase in BH recognition, it may be insufficient to improve care. Additional strategies may be needed to enhance engagement in BH services.
Authors: Karen A Hacker; Robert Penfold; Lisa Arsenault; Fang Zhang; Michael Murphy; Larry Wissow Journal: Pediatrics Date: 2013-12-02 Impact factor: 7.124
Authors: Nathalia Jimenez; Alex Quistberg; Monica S Vavilala; Kenneth M Jaffe; Frederick P Rivara Journal: Pediatrics Date: 2017-02-03 Impact factor: 7.124
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: 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