Friday, December 28, 2007

Rose D in Real Life: Screening in Practice

We began routine screening for behavioral and mental health issues in our office last week and I began to see the CRAFFTs and PEDS and PSC/PSC-Y forms appear on all of my "check-up" kids charts.  A few observations so far:
1)  Parents (and kids) mostly don't mind.  We haven't been hearing complaints from the parents in completing the forms, and the youth waiting in exam gowns seem to find that the form gives them something to do.  Our nurses say that they have had a few parents ask them what the questions mean on some of the forms, and we haven't run into a parent who is functionally illiterate (I am certain that that will happen, and will be embarrassing for all parties concerned).  But, in our first two weeks of screening, no push back.
2)  The PEDS generates lots of conversation, mostly not about major psychiatric problems.  The PEDS asks parents what they are worrying about in a lot of different areas, and most of their worried are about things like "intoeing" and "food texture".  Worse thing that I have found in the young kids so far is some temper tantrums, and the only referral has been for toileting issues (which, I grant you may evolve into something bigger).
3)  The PSC identified kids who we already knew were in trouble.  Most kids and parents identify a few problems, but the kid who we referred for counseling and psychiatric services earlier this year (and who is now almost ready to drop out of school) showed up loud and clear as having lots of problems on the screen.  Of course, we already knew that, so it is hardly a victory for screening.  Still, would have been worse if the PSC had not indicated the need for referral.
4)  Billing has become much more complicated.  We hae to mark many codes now with each visit.  Our office manager is checking the billing sheets to see that we are filling them out properly.  We will see if these things get paid by MassHealth without resulting in additional cost to our self-pay patients.
5)  Filing has become more complex.  There are many more bit of paper to put on rings.  Can't wait for an electronic medical record.

Anyone else have stories on screening?  Let us all know.  Also, check out the story in yesterday's Globe.  and Monday's Telegram and Gazette.  Actually, yesterday was the day of mental health conundrums, mostly outside of my EPSDT visits.  More on that another time.

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