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Behavioral Health Issue Screening and Use of Health Services

Behavioral Health Issue Screening and Use of Health Services. Deena J. Chisolm, PhD Columbus Children’s Research Institute & The Ohio State University. The TARAA Research Team. Kelly J. Kelleher, MD, MPH – Principal Investigator William Gardner, PhD - Co-Investigator

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Behavioral Health Issue Screening and Use of Health Services

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  1. Behavioral Health Issue Screening and Use of Health Services Deena J. Chisolm, PhD Columbus Children’s Research Institute & The Ohio State University

  2. The TARAA Research Team • Kelly J. Kelleher, MD, MPH – Principal Investigator • William Gardner, PhD - Co-Investigator • Jack Stevens, PhD - Co-Investigator • Deena J. Chisolm, PhD - Supplemental Co-Investigator • Lindsay Buchanan • Teresa Julian, CNP, PhD • Jennifer McGeehan, MPH • Funded by NIDA grant #R01MH078629-01

  3. Background • Routine screening for behavioral health issues in primary care is recommended by the AAP. • Standardized screening is not regularly done because of: • Limited time in the clinical encounter • Limited resources and increased cost for referral and care • Computerized self-interviews can help with the first limitation and yield information superior to that in face-to-face interviews for sensitive topics.

  4. Trial of Automated Risk Assessment in Adolescents • Goal: To improve recognition and treatment of behavioral health problems in adolescents in primary care through: • Risk screening in the primary care waiting room using wireless web-tablets • Immediate provision of scored screening results to clinicians (3 day delay as a control condition) • Motivational Interview follow-up calls for substance users (phase II) • Setting nine urban primary care clinics

  5. Preliminary Results • 95% were satisfied with their experience and satisfaction did not vary by race, payor, computer experience, or risk status. • Clinicians in the immediate results group were more likely to recognize behavioral health issues than those who received delayed results.

  6. Research Question • Do youth who screen positive for behavioral health issues in primary care use more services in the following 6 months than those who screen negative?

  7. MethodsIndependent Variables • Mutually exclusive behavioral health issue categories: • None • depression – score of >=25 on the CES-DC • suicidal thoughts – serious thought of ending life past 30 days (PHQ-A) • violence risk – physical fighting or carrying a weapon (YRBS) • substance use – alcohol, marijuana, or inhalants (CASI-A) • multiple risks • Potential Confounders: age, gender, service use in previous six months, payor

  8. MethodsOutcome Variables • Used data warehouse to gather all visits six months before and six months after screening. • Service Use Variables • Any visit • Mental Health related visit – any visit with a diagnosis code included in Clinical Classification Software (CCS) Codes 66-74

  9. MethodsAnalysis • Relationships between behavioral health issues and probability of use were tested using chi-squared and logistic regression. • Multivariate relationship between behavioral health issues and number of visits were tested using negative binomial regression.

  10. Sample Characteristics • 1,524 youth ages 11-20 • 72% under age 16 • 57% female • 65% non-white • 76% covered by Medicaid

  11. Positive Screens

  12. Probability of Service Use Within 6 MonthsBy Risk Category

  13. Adjusted Odds Ratios for Service Use (reference=no risk) *Odds ratios adjusted for gender, age group, prior use, and study arm

  14. Six Month Visit rate per 100 Youth *Difference in visit counts (reference=none) tested using negative binomial regression controlling for age group, gender, use in previous 6 months, and study arm

  15. Conclusions • Self-reported behavioral health issues factors are common in adolescents seen in primary care. • Youth who screen positive for depression, violence, or multiple risks have higher mental health service use after screening than those with no behavioral issues. • Mental health services use in those who screen positive for depression are still below optimal.

  16. Implications • Primary care screening programs may increase treatment for behavioral problems while creating limited additional burden in the health care system. • Systems should consider developing case management approaches for youth with identified behavioral health problems to ensure appropriate use of services.

  17. Thank You Questions?

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