Increases in behavioral health screening in pediatric care for Massachusetts Medicaid patients

Abstract

Objective: To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the state's new court-ordered screening and intervention program.

Design: Retrospective review of the number of pediatric well-child visits, number of screens, and number of screens that identify risk for psychosocial problems from January 2008 (the month pediatric screening started) to March 2009. During the surrounding 1-year period, we also examined the number of claims with a behavioral health evaluation code.

Setting: Massachusetts.

Participants: Massachusetts Medicaid-enrolled children.

Intervention: Funded court-ordered mandate to screen for mental health during Medicaid well-child visits.

Outcome measures: Percentage of visits with a screen, percentage of screens identified at risk, and number of children seen for behavioral health evaluations.

Results: Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period.

Conclusions: The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.

Figure 1

Percentage of Medicaid-enrolled children with screens for mental health (blue), percent of “modified” screens with behavioral health (BH) problems identified (red), and number of children with a mental health evaluation (grey).