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Psychiatr Serv. 2017 Jan 1;68(1):25-32. doi: 10.1176/ Epub 2016 Sep 1.

The Impact of the Massachusetts Behavioral Health Child Screening Policy on Service Utilization.

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Dr. Hacker is with the Allegheny County Health Department and with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (e-mail: ). 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, and Harvard Medical School, Boston. Dr. Zhang and Dr. Soumerai are with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Healthcare Institute, Boston. Dr. Wissow is with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore.



In 2008, Massachusetts Medicaid implemented a pediatric behavioral health (BH) screening mandate. This study conducted a population-level, longitudinal policy analysis to determine the impact of the policy on ambulatory, emergency, and inpatient BH care in comparison with use of these services in California, where no similar policy exists.


With Medicaid Analytic Extract (MAX) data, an interrupted time-series analysis with control series design was performed to assess changes in service utilization in the 18 months (January 2008-June 2009) after a BH screening policy was implemented in Massachusetts and to compare service utilization with California's. Outcomes included population rates of BH screening, BH-related outpatient visits, BH-related emergency department visits, BH-related hospitalizations, and psychotropic drug use. Medicaid-eligible children from January 1, 2006, to December 31, 2009, with at least ten months of Medicaid eligibility who were older than 4.5 years and younger than 18 years were included.


Compared with rates in California, Massachusetts rates of BH screening and BH-related outpatient visits rose significantly after Massachusetts implemented its screening policy. BH screening rose about 13 per 1,000 youths per month during the first nine months, and BH-related outpatient visits rose to about 4.5 per 1,000 youths per month (p<.001). Although BH-related emergency department visits, hospitalization and psychotropic drug use increased, there was no difference between the states in rate of increase.


The goal of BH screening is to identify previously unidentified children with BH issues and provide earlier treatment options. The short-term outcomes of the Massachusetts policy suggest that screening at preventive care visits led to more BH-related outpatient visits among vulnerable children.


Assessment/psychiatric; Behavioral health screening; Pediatric care

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