title: Behavioral Health Screening among Massachusetts Children Receiving Medicaid.
abstract: OBJECTIVE
  To assess the impact of a Massachusetts Medicaid policy change (the Children's Behavioral Health Initiative; CBHI, which required and reimbursed behavioral health [BH] screening with standardized tools at well child visits and developed intensive home- and community-based BH services) on primary care practice examining the relationship of BH screening to subsequent BH service utilization.
  
  
  METHODS
  Using a repeated cross-sectional design, our 2010 and 2012 Medicaid study populations each included 2000 children/adolescents under the age of 21 years. For each year, the population was randomly selected and stratified into 4 age groups, with 500 members selected per group. Two data sources were used: medical records and Medicaid claims.
  
  
  RESULTS
  The CBHI had a large impact on formal BH screening and treatment utilization among children/adolescents enrolled in Medicaid. Screening increased substantially (73%: 2010; 74%: 2012) since the baseline/premandate period (2007) when only 4% of well child visits included a formal screen. BH utilization increased among those formally screened but decreased among those with informal assessments.
  
  
  CONCLUSIONS
  CBHI implementation transformed the relationship between primary care and BH services. Changes in regulation and payment resulted in widespread BH screening in Massachusetts primary care practices caring for children/adolescents on Medicaid.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA; Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Savageau
authors.affiliation: Department of Pediatrics, University of Colorado, Denver, CO.
authors.forename: David
authors.initials: D
authors.lastname: Keller
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA.
authors.forename: Georgianna
authors.initials: G
authors.lastname: Willis
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Muhr
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA.
authors.forename: Gideon
authors.initials: G
authors.lastname: Aweh
authors.affiliation: Children's Behavioral Health Initiative, Massachusetts Executive Office of Health and Human Services, Boston, MA.
authors.forename: Jack
authors.initials: J
authors.lastname: Simons
authors.affiliation: Children's Behavioral Health Initiative, Massachusetts Executive Office of Health and Human Services, Boston, MA.
authors.forename: Emily
authors.initials: E
authors.lastname: Sherwood
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology*; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008404:Massachusetts; D008484:Medicaid; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: primary care; well child visits