Behavioural Health Screening and Service Use in a Statewide Sample of MedicaidEligible Pediatric Outpatients

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.