In a clinical report, the American Academy of Pediatrics highlights the important role of behavioral screening in identifying and treating child behavioral and emotional problems.1 Psychosocial and behavioral assessment is also a key element in the screening program recommended by the American Academy of Pediatrics’ Bright Futures, which offers theory-based and evidence-driven guidance for all preventive care screenings and well-child visits.
Social-emotional screening tools are better at identifying young children at risk for behavioral and social-emotional issues than broad developmental screening tools.2 In a study of low-income children from two to 60 months old, less than half of the 14 percent of children who had a positive screen on the Ages & Stages Questionnaire: Social Emotional (ASQ:SE), a validated social-emotional screening tool, had a positive screen on the Ages & Stages Questionnaire, Third Edition (ASQ-3), a validated broad developmental screening tool. In a study of children aged six months to 5.5 years in foster care, significantly more children with social‐emotional problems were identified with the ASQ‐SE than with the ASQ, Second Edition.3
Mandatory behavioral health screening at well-child pediatric visits results in increased use of formal social-emotional screening tools and behavioral health services. As part of the Rosie D. court decision in 2007, Massachusetts Medicaid established a requirement that primary care providers conduct behavioral health screening at well-child visits. A number of studies using various types of administrative data explored changes in screening practices, risk identification, and mental health service usage following the introduction of the requirement.
Medicaid data from the first year after the requirement showed that screening increased from 16.6 percent of well-child visits to 53.6 percent. Comparing September 2008 and 2009, mental health evaluations increased approximately 25 percent.4 Medicaid data for fiscal year 2009 showed that 46 percent of eligible children had evidence of screening, with 12 percent having a positive screen. Of children with a positive screen, 43 percent had no previous behavioral health history, suggesting they were newly identified by the mandatory screening. These children were more likely to be female, younger, minority, and from rural residences5. Of children enrolled in Medicaid from fiscal year 2008 through 2010, 45 percent were screened, according to Medicaid data. A positive screen increased the chance of receiving services from 10 to 30 percent.6 A comparison using medical record and Medicaid data from fiscal year 2007 and fiscal years 2010 and 2012 showed that rates of screening at well-child visits with a formal tool increased from 4 percent to 73-74 percent and the use of behavioral health services also increased.7