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Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization
Karen A Hacker1, Robert B Penfold1, Lisa N Arsenault1
1Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: khacker@achd.net ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
Insights
Implementing a pediatric behavioral health screening and colocation model increased specialty and primary care visits for children. However, emergency department visits for behavioral health concerns also rose significantly after the model
Area of Science:
- Pediatric Health
- Behavioral Health Services
- Healthcare Delivery Models
Background:
- Pediatric behavioral health issues are prevalent and often undertreated.
- Integrated care models aim to improve access to behavioral health services for children.
- Colocation of social workers in pediatric settings is a strategy to enhance care coordination.
Purpose of the Study:
- To evaluate the impact of a pediatric behavioral health screening and colocation model on healthcare utilization.
- To assess changes in ambulatory, emergency, and inpatient behavioral health service use among children.
- To compare utilization trends before and after the implementation of the integrated care model.
Main Methods:
- An interrupted time-series study design was employed.
- Data from 11,223 children (ages 4 years 9 months to 17 years 3 months) were analyzed.
- Behavioral health utilization was examined over 18 months pre-intervention and 30 months post-intervention.
Main Results:
- Specialty behavioral health visit rates increased by 20.4% cumulatively.
- Primary care behavioral health visit rates saw a 67.7% cumulative increase.
- Behavioral health emergency department visit rates surged by 245% compared to expected trends.
Conclusions:
- The pediatric behavioral health screening and colocation model led to increased engagement in behavioral health treatment.
- An unexpected rise in behavioral health emergency department visits was observed.
- Further research is necessary to understand the reasons behind the increase in emergency department visits, differentiating between care organization effects and broader utilization trends.
Objective:
The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care.
Methods:
In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupted time-series study was conducted to determine the impact on behavioral health care utilization in the 30 months after model implementation compared with the 18 months prior. Specifically, the change in trends of ambulatory, emergency, and inpatient behavioral health utilization was examined. Utilization data for 11,223 children ages ≥4 years 9 months to <18 years 3 months seen from 2003 to 2008 contributed to the study.
Results:
In the 30 months after implementation of pediatric behavioral health screening and colocation, there was a 20.4% cumulative increase in specialty behavioral health visit rates (trend of .013% per month, p=.049) and a 67.7% cumulative increase in behavioral health primary care visit rates (trend of .019% per month, p<.001) compared with the expected rates predicted by the 18-month preintervention trend. In addition, behavioral health emergency department visit rates increased 245% compared with the expected rate (trend .01% per month, p=.002).
Conclusions:
After the implementation of a behavioral health screening and colocation model, more children received behavioral health treatment. Contrary to expectations, behavioral health emergency department visits also increased. Further study is needed to determine whether this is an effect of how care was organized for children newly engaged in behavioral health care or a reflection of secular trends in behavioral health utilization or both.
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