J. Michael  Murphy,Alexa  Riobueno-Naylor,Haregnesh  Haile,Holcomb  Juliana M,Anamika  Dutta,Rao  Kandru,Amy  M. Shui,Hang  Lee,Michael  Jellinek,
Behavioural Health Screening and Service Use in a Statewide Sample of MedicaidEligible Pediatric Outpatients
Psychological Disorders and Research
2020
2674-2470
http://dx.doi.org/10.31487/j.PDR.2020.03.04
https://www.sciencerepository.org/behavioural-health-screening-and-service-use-in-a-statewide-sample_PDR-2020-3-104 
Abstract: Objective: This study explored site-level rates of behavioural health (BH) screening, positive screening,
and BH service use in statewide data from the largest Medicaid Health Maintenance Organization in
Massachusetts.
Methods: Screening rates at annual well-child visits (WCVs) were assessed across 908 sites (practices) for
patients ages 4-17 between 2014-2018. The primary analytic sample included WCVs in 2016 (N=76,752)
and was restricted to sites with at least 30 WCVs (N=304 sites; N=72,842 patients). Use of BH services was
assessed six months before and after the index WCV.
Results: The mean WCV screening rate across the analytical sample was 71.2% (SD=31.3; range=0.0-
100.0%) and the mean positive screening rate was 7.2% (SD=12.7, range=0-100%). Using intra-class
correlations, small, but meaningful differences, were found between sites in rates of overall (r=0.38; 95%
CI=0.25-0.50) and positive (r=0.10; 95% CI=0.00-0.29) screening. Although the relationship between a
site’s rate of screening and the rate of BH treatment failed to reach statistical significance, there was a nonsignificant correlation (r=0.08, p=0.17) in the predicted direction and sites that screened at or above the
mean screening rate (71.9% of their WCVs) were significantly more likely to have 6.0% or more of their
patients receive subsequent BH services than were sites with screening rates below 71.9% (67.2% vs. 51.2%,
p<.05).
Conclusion: The current study documented a high level of continued compliance with the statewide
mandate for routine psychosocial screening after more than a decade, although there were some relatively
small decreases in compliance in recent years. The study also found that there were significant differences
between sites in rates of BH screening and positive screening and a relationship between site-level rates of
screening and service use.Keywords:  Behavioural health screening, early and periodic screening, diagnosis and treatment, EPSDT, the children’s behavioural health initiative, CBHI, pediatric primary care