Rosie D in Practice: Report from the Field

Our UMass annual faculty retreat was this weekend, and the assembled 31 primary care pediatricians heard a wonderful talks by our MCPAP about screening for serious emotional disturbance, and treatment of depression.  In the course of the discussion,  I was struck by some of the comments about the implementation of the Child Behavioral Health Initiative.  Folks are, in general, doing the screening, identifying kids with problems and still having difficulty in referring kids for services.  Specifically:

• The screens, particularly the PEDS and the PSC, have a lot of "noise"- they identify concerns that are not actually associated with mental illness.
  
• Parents are really tired of filling out the PEDS on multiple occasions.
• One office tried to use the ASQ, and found that it took too long.
• A few offices have run into billing issues, where patients with private insurance get bills for the screening code, saying that they won't pay for it.  Nurse practitioners also have real problems with this.
• Usual resources are getting more swamped than before.

None of these are a surprise.  As I've written before in this blog, screening is in place with only a few glitches.  The CANS, the CSAs, the wraparound services-  this will be where the rubber meets the road.