198295 Screening for child mental health; What about those that don't show up?

Tuesday, November 10, 2009: 4:45 PM

Karen Hacker, MD MPH , Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Sandra Williams, SM , Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
The use of behavioral health screening tools at the annual pediatric visit has been recommended and mandated in some states. In order to be screened, patients need to show up for preventive care. We explored the follow-up of 2129 children screened for mental health using the Pediatric Symptom Checklist (PSC) in an urban pediatric practice to determine the differences between those that returned for preventive care and those that did not.

Over 30% (660) of the sample did not return for a preventive care visit in 10-18 months. Non-returners were divided into three groups; those that did not return for any visits after their first well child visit (“noshows” n=250); those that came for an ambulatory visit with or without emergency room visits (“acute care seekers” n=330), and those that only came for emergency visits (“ED users” n=82). These groups varied significantly by age, race, language and insurance type. The population that returned for preventive visit had a significantly lower rate of positive PSC scores compared to ED users (5% compared to 13%) Additionally, the mental health referral rate was significantly higher for all non-returner groups compared to returners.

Pediatricians screening for mental health issues at the annual visit must be aware of populations that are at high risk for non-compliance with preventive care and their increased risk for mental health issues. They should consider following identified mental health problems at inter-periodic visits and recognize that populations using ED services are at higher risks overall for mental health issues.

Learning Objectives:
Describe the differences in mental health screening scores between children who were compliant with subsequent preventive care and those who were non-compliant.

Keywords: Screening, Child and Adolescent Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator on the study that provided data for this presentation. I have extensive experience with mental health screening in pediatric practice and have written several articles and presented on the topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.