Monday, August 18, 2008

Screening in our office: How is it going eight months on?

So, how goes the screening you ask? Turns out, at least in my office, we have some information about how that is going, from some ongoing reporting that we are doing to the Dpeartment of Public Health through another project. Last month, we screened 98 adolescent patients (about 8% of our adolesent patient panel) with the Y-PSC and the CRAFFT. The Y-PSC was completed by 95 of them; of those, 9 or 10% screened positive. We CRAFFTed all of them (we are doing the CRAFFT verbally, as part of the routine well child visit, identified 6 as positive (6%). There was, as you would expect, some overlap between the two groups. Our success at referral was less impressive; of the 12 kids identified as troubled, 1 was already in treatment and 2 made it into treatment. The rest will be back; in primary care, they always come back.

By the way, this group of adolescents mostly had private insurance (15% Medicaid, which is lower than our usual case mix). Not sure why. But we do see a lot of sports physicals in the summer.

What does this tell us? First, that the screening instruments work reasonably well, at least in adolescents, finding about what we thought they would find. Second, that,even with screening, we can’t get our patients into treatment. This is not a consequence of MassHeath. To us, it seems a consequence of motivation (both parent and youth don’t like the idea of treatment for substance abuse and mental health problems), time (hard to make the schedules work, especially when all of parents, both single and partnered, have jobs) and mindset (a lot of people still think that you can stop mental illness through force of will). Third, if we were ever successful in referring everthing that we found, we would swamp the system. 12 teens per month adds up to 144 teens per year, multiply by 1700 pediatricians around the state and you have 28,000 intakes waiting to happen. Again, only 25% of those are MassHealth patients (maybe more), but that’s a lot of work waiting to be done. Surely there are a lack of resources, but, in order to improve them, we need to use the ones that we already have.

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