Sequential Screening to Improve Behavioral Health Needs Detection in Primary Care

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.