title: Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization.
abstract: OBJECTIVE
  The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care.
  
  
  METHODS
  In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupted time-series study was conducted to determine the impact on behavioral health care utilization in the 30 months after model implementation compared with the 18 months prior. Specifically, the change in trends of ambulatory, emergency, and inpatient behavioral health utilization was examined. Utilization data for 11,223 children ages ≥4 years 9 months to <18 years 3 months seen from 2003 to 2008 contributed to the study.
  
  
  RESULTS
  In the 30 months after implementation of pediatric behavioral health screening and colocation, there was a 20.4% cumulative increase in specialty behavioral health visit rates (trend of .013% per month, p=.049) and a 67.7% cumulative increase in behavioral health primary care visit rates (trend of .019% per month, p<.001) compared with the expected rates predicted by the 18-month preintervention trend. In addition, behavioral health emergency department visit rates increased 245% compared with the expected rate (trend .01% per month, p=.002).
  
  
  CONCLUSIONS
  After the implementation of a behavioral health screening and colocation model, more children received behavioral health treatment. Contrary to expectations, behavioral health emergency department visits also increased. Further study is needed to determine whether this is an effect of how care was organized for children newly engaged in behavioral health care or a reflection of secular trends in behavioral health utilization or both.
authors.affiliation: Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: khacker@achd.net ). 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. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Hacker
authors.affiliation: Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: khacker@achd.net ). 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. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.affiliation: Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: khacker@achd.net ). 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. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Arsenault
authors.affiliation: Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: khacker@achd.net ). 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. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: khacker@achd.net ). 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. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.affiliation: Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: khacker@achd.net ). 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. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Wissow
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000639:trends*; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D010372:Pediatrics / Q000639:trends*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis