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Sequential Screening to Improve Behavioral Health Needs Detection in Primary Care.

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  • 1Medical College of Wisconsin, Milwaukee; Children's Hospital of Wisconsin, Milwaukee.

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|August 4, 2018
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Summary

Sequential screening improves pediatric behavioral health detection while reducing unnecessary referrals. Careful selection of screening tools and implementation strategies are key to maximizing benefits and minimizing costs in primary care settings.

Keywords:
base rate fallacyintegrated behavioral healthprimary carescreeningsequential screening

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Area of Science:

  • Pediatric Primary Care
  • Behavioral Health Screening
  • Health Services Research

Background:

  • Pediatric primary care settings face challenges in effectively detecting behavioral health needs.
  • Traditional single-measure screening may lead to unnecessary referrals and missed diagnoses (false negatives).
  • Optimizing screening protocols is crucial for improving patient outcomes and resource allocation.

Purpose of the Study:

  • To evaluate sequential screening strategies for enhancing behavioral health needs detection in pediatric primary care.
  • To assess the potential of sequential screening to reduce unnecessary referrals.
  • To discern the adverse impacts, specifically false negatives, associated with different screening approaches.

Main Methods:

  • Utilized Monte Carlo simulation to model six sequential screening programs.
  • Incorporated technical properties of three broadband behavioral health measures and psychopathology base rates.
  • Employed descriptive statistics, power regression, and data visualization for comparative analysis.

Main Results:

  • The ratio of reduced referrals to net false negatives varied based on measure choice, administration order, and instrument properties.
  • One specific program (SDQ-PSC) demonstrated a favorable ratio (approx. 12.8:1) at low prevalence (3%), despite comparable overall sensitivity/specificity to other programs.
  • Performance metrics were sensitive to the base rate of psychopathology in the pediatric population.

Conclusions:

  • Sequential screening presents a viable alternative to traditional single-measure behavioral health screening in primary care.
  • Deliberate selection and implementation of screening instruments are essential for maximizing benefits and minimizing costs.
  • Further investigation into practical aspects of sequential screening workflows is needed to fully understand its advantages in pediatric care.