Purpose: Mental health (MH) and developmental screening across the pediatric lifespan is a best practice according to the American Academy of Pediatrics and is even mandated in some states. Screening, especially in early childhood, facilitates prompt identification of MH and developmental concerns and linkage to services if needed. Importantly, it can also serve as a tool to provide education to families about healthy child development and facilitate discussions about mental well-being. Despite the known benefits, there is a gap in the literature examining real-world adherence to screening recommendations in the medical home setting and the results of universal screening across a broad age range. Objectives/goals: To: 1) describe the screening rates for MH and developmental screening; 2) describe the prevalence of abnormal screens across the pediatric lifespan. Methods: We analyzed screening data from January 2017 through December 2018 in a large, urban, academic primary care group serving 40,000 largely minority, low-income patients. Screening tools included in this analysis were the Edinburgh Postnatal Depression Scale (EPDS), Ages and Stages Questionnaire (ASQ), ASQ:Social Emotional (ASQ:SE), Modified Checklist for Autism in Toddlers-Revised (MCHAT-R), Strengths and Difficulties Questionnaire (SDQ), and the Patient Health Questionnaire-9 (PHQ-9). The electronic medical record was queried to generate screening rates and prevalence of abnormal results using validated cut-off scores for the six screening tools. Results: Screening rates within the medical home varied by screening tool and age at visit. Screening rates ranged from a low of 69% for the ASQ:SE at the 3 year visit to a high of 88% for the SDQ for youth 11-17 years old. The prevalence of abnormal results also varied by age at visit with the ASQ at the 18 month visit yielding the highest percentage of abnormal results at 24%, and the MCHAT yielding the lowest percentage of abnormal results at 5% for both the 18 and 24 month visits. See Table 1 for additional results. Conclusion: These results illustrate one large pediatric medical home’s experience with implementing routine MH and developmental screening. Further investigation is needed to understand the variability in screening rates. Ongoing quality improvement work will be needed to sustain and improve these rates. An appreciation for screening results across the pediatric lifespan may be helpful for other large health centers looking to advance their screening practices in terms of anticipating service needs and advocating for appropriate specialty and community-based support.
Universal Mental Health and Developmental Screening in the Medical Home: Screening Rates and Prevalence of Abnormal Results
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Melissa Long, Penelope Theodorou, Michaela Morton, Leandra Godoy, Lee Beers, Cara Biddle; Universal Mental Health and Developmental Screening in the Medical Home: Screening Rates and Prevalence of Abnormal Results. Pediatrics July 2020; 146 (1_MeetingAbstract): 33. 10.1542/peds.146.1MA1.33a
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