title: Behavioral health services following implementation of screening in Massachusetts Medicaid children.
abstract: OBJECTIVE
  To determine the relationship of child behavioral health (BH) screening results to receipt of BH services in Massachusetts Medicaid (MassHealth) children.
  
  
  METHODS
  After a court decision, Massachusetts primary care providers were mandated to conduct BH screening at well-child visits and use a Current Procedural Terminology code along with a modifier indicating whether a BH need was identified. Using MassHealth claims data, a cohort of continuously enrolled (July 2007-June 2010) children was constructed. The salient visit (first use of the modifier, screening code, or claim in fiscal year 2009) was considered a reference point to examine BH history and postscreening BH services. Bivariate and multivariate logistic regression analyses were performed to determine predictors of postscreening BH services.
  
  
  RESULTS
  Of 261,160 children in the cohort, 45% (118,464) were screened and 37% had modifiers. Fifty-seven percent of children screening positive received postscreening BH services compared with 22% of children screening negative. However, only 30% of newly identified children received BH services. The strongest predictors of postscreening BH services for children without a BH history were being in foster care (odds ratio, 10.38; 95% confidence interval, 9.22-11.68) and having a positive modifier (odds ratio, 3.79; 95% confidence interval, 3.53-4.06).
  
  
  CONCLUSIONS
  Previous BH history, a positive modifier, and foster care predicted postscreening BH services. Only one-third of newly identified children received services. Thus although screening is associated with an increase in BH recognition, it may be insufficient to improve care. Additional strategies may be needed to enhance engagement in BH services.
authors.affiliation: Allegheny County Health Department, and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; khacker@ACHD.net.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Hacker
authors.affiliation: Group Health Research Institute, and Department of Health Services Research, University of Washington, Seattle, Washington;
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.affiliation: Institute for Community Health, Cambridge Health Alliance.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Arsenault
authors.affiliation: Harvard Pilgrim Healthcare Institute, Department of Population Medicine, and.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Massachusetts General Department of Child Psychiatry, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Michael
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Wissow
mesh_terms: D000293:Adolescent; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D002662:Child Health Services / Q000331:legislation & jurisprudence / Q000379:methods* / Q000639:trends; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000331:legislation & jurisprudence / Q000379:methods* / Q000639:trends; D008404:Massachusetts / Q000453:epidemiology; D008484:Medicaid / Q000331:legislation & jurisprudence / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: Medicaid; behavioral health services; children; primary care; screening