Sunday, March 15, 2009

The problem with a positive screen.....and getting interpreters out into the community.

So, I was a little clinical last week-  three days in the office, with children vomiting and limping and needing their physicals all about me.  During that time, I saw three teens who were clearly having trouble with marijuana use.  Two were in for physicals and one had been taken to the ER for a medical condition over the weekend, where he was found to be using weed.  Interestingly, all had normal Psychosocial Checklists, but abnormal CRAFFTs.  All of them needed treatment.  None of them wanted it.  So none were actually "referrals", the only positive outcome allowed on the MassHealth billing form that is feeding into the data of which we look, and all were negative on the "usual screen" that we use for a first pass.  I couldn't refer;  I tried Motivational Interviewing.
I was sort of successful;  all agreed not to drive while stoned, none agreed to a trial of abstinence, one agreed that weed would hurt his chances of getting a scholarship to college, and all agreed to a follow up.  
But how will that count for Rosie D?  I could score the screening code for the PSC, not the CRAFFT and make it a negative.  Thats not right- the kids did have problems.  I could count the follow-up visit as a self-referral, although that seems a bit disingenuous.  I think, in the end, I scored them as positive screen with referral.  I am optimistic that I will be able to talk them through the process.
Many such stories lurk behind the simple numbers going to the CBHI and the Court, as Rosie D falls into place.  Those interpreting the billing data need to keep that in mind.
In a separate matter, I want to tell all of you who have not had access to interpreter services in the past, finally getting them is wonderful.  Our office in Webster doesn't have sufficient volume to support on-site interpreter services, and we have not had "phones in the rooms" to support telephonic interpretation.  Recently, however, we (UMass) got access to telephonic interpretor services, AND I got a cell phone with speaker capability, which would allow me to have the interpreter "in the room" in real time.  So, on Friday, I saw a Polish-speaking couple (who understand some English, but have trouble asking questions in Polish) with a young boy with frequent urination.  Now this is a potential medical problem, but more commonly is a behavioral habit;  one can distinguish the two pretty quickly, and, with some simple behavioral instruction, this can be handled without  much trouble.  I did the simple stuff to show that this was not diabetes, while thinking that this usually takes a bit of discussion (in English) to get parents to understand what is going on, and that this would be a challenge with this family.  Then I remembered my new phone, and got an interpreter on the speaker.  It was great- the family left happy, understanding what they were going to need to monitor over the next few weeks, and I felt that I was able to address their concerns in a complex situation.  If you don't have this service available in your office, find it.  It is great.
Complicated day.

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