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

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.