title: Mental and behavioral health screening at preventive visits: opportunities for follow-up of patients who are nonadherent with the next preventive visit.
abstract: OBJECTIVE
  To determine the type of subsequent care received by children nonadherent with their next preventive visit and whether behavioral factors predict use of emergency or acute care in this population.
  
  
  METHODS
  Data on 1703 children (4-16 years) screened at a preventive visit with the Pediatric Symptom Checklist (PSC)/Youth-PSC were examined to determine subsequent preventive care adherence (10-18 months later). Then, nonadherent children were monitored to determine whether they returned to their medical home for acute care, delayed preventive care, or visited the emergency department (ED). Multivariate analyses were conducted to determine whether demographic and behavioral factors predicted return to either acute care or ED care site.
  
  
  RESULTS
  Of the 461 children who were nonadherent with a second preventive care visit, most (85%) subsequently returned for acute, emergency, or delayed preventive care in the same medical system. Predictors of acute care or ED use included behavioral health risk characteristics (positive PSC, counseling, referral, parental concern), as well as adolescent age, self-pay and public insurance status, and living in lower socioeconomic communities.
  
  
  CONCLUSIONS
  Pediatricians should consider acute care or ED visits as opportunities for mental health screening follow-up, and intervention in populations at high risk who miss preventive care.
authors.affiliation: Institute for Community Health, Cambridge Health Alliance, Cambridge, MA 02141, USA. Khacker@challiance.org
authors.forename: Karen A
authors.initials: KA
authors.lastname: Hacker
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Arsenault
authors.forename: Sandra
authors.initials: S
authors.lastname: Williams
authors.forename: Ann M
authors.initials: AM
authors.lastname: Digirolamo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control*; D015999:Multivariate Analysis; D010349:Patient Compliance; D018802:Patient-Centered Care; D011314:Preventive Health Services / Q000458:organization & administration*