Monday, January 5, 2009

Change is Here: How many kids Have we screened so far?

I had a chance to read the latest report on the Rosie D. remedy on the Rosie D website last night.  According to the Child Behavioral Health Initiative, formal behavioral health screening under EPSDT has increased drastically since the CBHI began training and Medicaid began reimbursing pediatric health providers for screening using one of nine approved screening instruments.  In the last quarter,  40%-50% of those eligible for screening got it.  Now, these data come from billing records and billing sometimes lags behind practice, but in their last report to the Court, the CBHI said that roughly 40% of children who had a health maintenance visit under EPSDT were screened.  Over the first nine months of 2008, over 100,000 screens were performed, and, on average, about 10% of them were positive.  Please keep in mind that, for the younger children, more than one screen may have been performed over the course of a year, but this implies that something on the order 10,000 children have been identified as warranting further investigation for behavioral health problems in the Commonwealth of Massachusetts.  

10,000 children identified.  With only 40% of the screens done that we intend to happen eventually.  Now, all of these children do not have Serious Emotional Disturbances,  but most of them will require more than a pat on the head to help with these issues.  My experience, especially with the PSC, is that it doesn't find mild problems.  I have also found that it is sometimes hard to convince those with problems to seek help.  But, our statewide experience to date says that there are a lot of kids out there who need help, and that we best get on with this CSA process so that we can help them.  This tidbit of information has just whet my appetite for more information.  How accurate were these screens?  How many of the families that were identified as needing help wanted help?  How many of the families identified as needing help were able to get it?  How often was the help helpful?  Did any of this massive effort make a difference in the lives of the Commonwealth's children? 

MassHealth and the CBHI have done a great job in bringing us to this point.  We have integrated behavioral health into the thinking of the pediatric workforce on a scale that is scarcely matched in the country.  We screen, we identify,  and we try to make the system work for children.  And we will do more of this over the coming year.  They are to be congratulated for leading us to this point.

Screening was the easy part.  Now we have some real work to do.

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