The Integration of Routine Behavioral Health ScreeningInto Pediatric Primary Care

Barbara Ward-Zimmerman, Ph.D.Child Health and Development Institute of Connecticut, Inc.Wheeler Clinic

Learning Objectives

Increased appreciation of the need for, and benefits of, behavioral health screening in , gpediatric primary careEnhanced understanding of the mandates for b h i l h lth ibehavioral health screeningGreater knowledge of screening toolsI d f ili it ith ffi dIncreased familiarity with office procedures which facilitate the implementation of a screening programg p gAwareness of the range of roles for psychologists in assisting pediatric primary care providers to detect and address behavioralproviders to detect and address behavioral health concerns

The Vision

Universal Behavioral Health

Screening in PediatricScreening in Pediatric Primary Care

Routinely practicedSystematically scheduledAcross development“Basic office equipment”

(Jellinek & Murphy 2004)(Jellinek & Murphy, 2004)

The Goals

Improved behavioral health for all children

Decreased incidence of behavioral health disorders

Improved family functioning

Enhanced family-primary care partnerships

An accessible and seamless continuum of behavioral health services that fill the demandbehavioral health services that fill the demand

Why screen for behavioral health disorders?

Behavioral health disorders are among the most prevalent sources of morbidity for children in the 21st century (Weitzman & Leventhal, 2006)

Half of all mental health problems start by age 14 (Kessler, Berglund, Demler, Jin, & Walters, 2005)

90% of all substance addictions begin in the teen years (National Center on Addiction & Substance Abuse, 2011)

The 20/20 problem: 20% of U.S. children are in need of behavioral health services but only 20% of those in need receive such services y(Society for Research in Child Development, 2009)

Our failure to adequately identify and address the behavioral health needs of children has lead to tragic consequences including:

suicide substance abuse school failure incarcerationunemployment physical symptoms (Saywitz & Nabors, 2005)

later life health problems (Shonkoff, Boyce, & McEwen, 2009)

We are all affected by this failure (individuals, families, schools, communities, employers, the nation as a whole) (Saywitz & Nabors, 2005)

Why screen for behavioral health disordersin pediatric primary care?p p y

> 80% of children (ages birth to 17) are seen by their primary care physician each year (N ti l S f Child ’primary care physician each year (National Survey of Children’s Health, 2007)

Primary care physicians have early and ongoing contactPrimary care physicians have early and ongoing contact with children and their parents

Most parents view their primary care physician as aMost parents view their primary care physician as a resource for questions about child development and behavior (Jellinek & Murphy, 2004; National Survey of Early Childhood Health, 2000; Schor Perrin & Stancin 2006)2000; Schor, Perrin, & Stancin, 2006)

Screening for behavioral health disorders in primary care is consistent with the goals set forth for a Medical Homeis consistent with the goals set forth for a Medical Home (American Academy of Pediatrics Policy Statement, 2002)

The Directives are ClearThe Early and Periodic Screening, Diagnostic, and Treatment(EPSDT) guidelines require that states provide regular health screenings

d ll di ll i t hild d d l tand all medically necessary services to children and adolescents, including assessments of mental health development

The Surgeon General (2000) called for a health care system thatThe Surgeon General (2000) called for a health care system that responds to the mental health and physical health needs of youth

System components: health promotion; disease prevention; early detection; and universal access to care;

The President’s New Freedom Commission on Mental Health (2003)Goal 4: Early Mental Health Screening, Assessment, and Referral to Services Are Common PracticeRecommendation 4.4: Screen for mental disorders in primary health care, across the life span, and connect to treatment and

tsupports

The Directives are ClearPediatric Guiding Principles prescribe that screening for developmental and behavioral health problems be conducted in primary carewww.aappolicy.orgpp y g

The American Academy of Pediatrics Policy Statement, “Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance andMedical Home: An Algorithm for Developmental Surveillance and Screening” (2006):

Developmental surveillance at every well-child primary care visitUse of validated developmental screening tools at 9, 18, 24 or 30* monthsUse of validated developmental screening tools at 9, 18, 24 or 30 monthsScreening for autism at 18 and 24 months

The American Academy of Pediatrics Policy Statement, “The Future of P di t i M t l H lth C t i f P di t i P i C ”Pediatrics: Mental Health Competencies for Pediatric Primary Care”(2009):

Practice to include prevention, identification, and treatment services for frequently occurring mental health conditions, e.g., anxiety, depression, and q y g , g , y, p ,substance abuseRange of behavioral health services to span from universal screening to delivery of brief office interventions for mental health concerns

The Directives are ClearPediatric Guiding Principles

The American Academy of Pediatrics Task Force on Mental Health (AAP Mental Health Toolkit, 2010)

Concluded:Screening with a validated tool is useful in identifying children with mental health problemsThe identification of problems and linkage to services improve outcomesScreening in a busy primary care practice is feasible

Proposed recommendations for mental health screening:0-5: Screen for socio-emotional problems with abnormal developmental screening tests at 9, 18, and 24 or 30 months or abnormal autism screening at 18 and 24 months, at times of poor growth, attachment symptoms, or regression, or family identifies a concern 5-Adolescence: Screen for symptoms of mental illness and psychosocial functioning5 Adolescence: Screen for symptoms of mental illness and psychosocial functioning difficulties at well-child visits and times of family disruption, poor school performance, behavioral difficulties, recurrent somatic complaints, or involvement with a social service or juvenile justice agency, or family identifies a concernAdolescence: Screen for substance use (including tobacco) at each health maintenance visit and when circumstances appear to warrant (e.g., injury, car crash)pp ( g , j y, )

Proposed recommendations for screening and surveillance of family and social environment risk factors:

Secure history of trauma exposure and updates on child and family’s psychosocial history (e.g., parental distress or discord, domestic violence, parental substance abuse or mental illness, f il i l t l ) t h ll hild i it d t dfamily social support, loss) at each well-child visit and as appears warrantedScreen for maternal depression in the first year of a child’s life (particularly between 6 weeks and 3 months) and when psychosocial history indicates

The Directives are Clear

Affordable Care Act www.HealthCare.govCovered Preventive Services for Children Include:Covered Preventive Services for Children Include:

Alcohol and drug use assessments for adolescentsAutism screening for children at 18 and 24 monthsBehavioral assessments for children of all ages (0-17)Behavioral assessments for children of all ages (0 17)Depression screening for adolescentsDevelopmental screening for children under age 3, and surveillance throughout childhood

Patient-Centered Medical Home (PCMH) The National Committee for Quality and Assurance (NCQA 2011)The National Committee for Quality and Assurance (NCQA, 2011) credentialing standards for a PCMH require:

Mental health and substance abuse assessment be part of a comprehensive health care approachp pp

Incentive: enhanced payments

Primary Care is an Ideal Setting for Behavioral Health Prevention, Early Detection, and Early Intervention, y , y

Yet, pediatricians significantly under-identify behavioral health treatment needs

(Glascoe, 2000; Schor, Perrin, & Stancin, 2006; Weitzman & Leventhal, 2006)

Between 40% to 80% of children with developmental or behavioral health problems are not identified whenbehavioral health problems are not identified when pediatricians rely on clinical judgment (Glascoe, 2000; Hix-Small et al., 2007)

Limited use of formal behavioral health screening toolsLimited use of formal behavioral health screening tools contributes to this under-identification (Glascoe, 2000)

A majority of primary care practitioners do not yetA majority of primary care practitioners do not yet routinely screen for mental health disorders (Halfon et al., 2004; Pidano, Kimmelblatt, & Neace, 2011, Weitzman, Edmonds, Davagnino, & Briggs-Gowan, 2011)

81% of parents nationwide reported no formal screening for risk of d l t l b h i l i l d l d t d d i h lthdevelopmental, behavioral, or social delays conducted during health care visits for their children ages 10 months to 5 years (National Survey of Children’s Health, 2007)

A Window of Opportunity for Psychologists

Barriers Commonly Cited for Limited Use of Behavioral Health Screening in Primary Care are Proving Invalidg y g

Anticipated Barrier Proven Experience

L k f Ti P di t i i id th ti h f dLack of Time Pediatric primary care providers across the nation have found that behavioral health screening can be completed quickly and efficiently

Lack of Staff No additional staff is required

Lack of Training Minimal training is needed and can be acquired through a variety of educational  venues, including the internet

Lack of Parental Acceptance The vast majority of parents are not only accepting but appreciative of screening practicesappreciative of screening practices

Concern that false‐positives will result in over‐referrals

Developmental surveillance and follow‐up by primary care provider decreases the likelihood of unnecessary referrals when screening results are in question

Inadequate Reimbursement In a growing number of states Medicaid and most private insurers   reimburse for developmental and behavioral health screening conducted at any primary care visit (health maintenance, sick, problem focused).  More than one screen per visit increasingly reimbursedreimbursed.

Unfamiliar or Unavailable Referral Sources

States are working to  address this barrier for children and families covered by Medicaid, challenges for privately insured

Reimbursement for Screening

In most states behavioral health and developmental screening can now bebilled on the same day as a well child exam or with any other visitbilled on the same day as a well-child exam or with any other visit

CPT Codes

96110 (developmental screening, with interpretation and report, per standardized instrument) covers office overhead, i.e., the practice and malpractice expenses in the use of a screening instrument p p g(nonphysician may give the instrument to the patient, score, and record but physician reviews)

The 96110 code is reported with the modifier -59 to identify that a di ti t d i d t d i dditi t th i it it lfdistinct procedure or service was conducted in addition to the visit itself

99420 covers administration and interpretation of health risk assessment instruments

What can psychologists do to promote universal behavioral health screening in pediatric primary care?g p p y

Provide In-Service TrainingPediatricians are interested in receiving training related to mental health skill development on topics such as screening (Pidano et al., 2011)

Role for Psychologists:•Conduct in‐service training for primary care providers to expand expertise in behavioral health screening 

In-Service Training to Promote Screening

Topics for Psychologists to Include:1 Practice logistics1. Practice logistics

Protocols for office procedures

2. Valid and reliable tool selectionAdministration and scoring

3. Approach to screeningSt i iStep-wise progressionResponse to positive screens

Topic 1: Practice Logistics

Model Developed by The North Carolina Assuring Better Child Health and Development Project (Earls & Hay, 2006)

Objectives:Assist practices in implementing an efficient and practical process for universal screeningFacilitate links to community services

Key steps to implementing a screening program:Assess current office protocolspIdentify a physician champion to maintain the initiative as a prioritySelect screening tool(s)Map the workflowIdentify system supports (networking with community partners is key)Conduct staff orientationsShare process and outcome data at regular intervals with staff

Topic 2: Tool Selection (Definition of Screening)

Screening:≠ evaluation, does not provide a diagnosis, identifies those in≠ evaluation, does not provide a diagnosis, identifies those in need of further assessment, designed for those thought to be developing normally (asymptomatic), a brief process, helps to formulate referral questions

Clarify DistinctionsScreening

First-stage screening looks at the entire population to identify those at risk and in need of further evaluation (generally through use of written measures)

Surveillance (Glascoe & Dworkin, 2005)

A continuous flexible and multifaceted process which focuses on the wholeA continuous, flexible, and multifaceted process which focuses on the whole child and includes: soliciting parental concerns; developmental and family history-taking; observations; and professional consultations

EvaluationAn individualized, in-depth, complex process which may be multidisciplinary in nature

Topic 2: Tool Selection (Criteria for Selecting Measures)

Psychometric ConsiderationsReliabilityy

the ability of the tool to produce consistent resultsValidity

the extent to which a tool measures what it is intended to measure

Sensitivitythe accuracy of the tool in identifying behavioral health disorders (70% to 80%)(70% to 80%)

Specificitythe accuracy of the tool in identifying those maintaining good behavioral health (70% to 80%)

Practical ConsiderationsCostAcceptability (to parents and staff)p y ( p )EfficiencyEffectiveness in guiding next step

Topic 2: Tool Selection (Making Choices)

Useful Resources for Selecting Measures Include:

American Academy of Pediatrics’ Mental Health Toolkit (2010)http://www.aap.org/commpeds/dochs/mentalhealth/docs/MH-ScreeningChart.pdf

Massachusetts General Hospital School Psychiatry Program & Madi Resource Center http://www2.massgeneral.org/schoolpsychiatry/screeningtools_table.asp

Massachusetts Primary Care Behavioral Health Screening Toolkit http://www.mcpap.com/pdf/PCCScreeningToolkitUpdate04292010.pdf

TeenScreen National Center for Mental Health Checkups at Columbia University www.teenscreen.org: Resource for primary care access to free adolescent screening tools and guidance for implementing screening programs

Topic 2: Tool Selection (Consider the Role of Electronic Screening)

Electronic Systems Administer, Score, and Analyze Online Measures with Potential Advantages:Conducted in either the patient’s home or in the officeConducted in either the patient s home or in the office

Pre-visit data collection from the patient’s home allows increased time for parent to consider responses and formulate questionsThe increasing use of handheld tablets allows for flexibility and growing possibilities in the office

Saves time for provider as tools are scored and interpreted immediatelyInformation can be collected from multiple adults (parents and teachers) with online consent to share dataPrimary care clinician aware of problems and strengths prior to a visit and can prepareFor adolescents: electronic screening is more likely to elicit concerns and may be viewed as more confidential than interviews or paper-and-pencil measures (AAP Mental Health Toolkit, 2010)A i t ith i l d lit h llAssists with overcoming language and literacy challenges

Measures are becoming available with audio tracks in a variety of languages, customization is possible

Facilitates quality improvement activitiesCreates patient registries; tracking progress over time for individual children sub-Creates patient registries; tracking progress over time for individual children, sub-groups, and entire populationAssists with program performance measurement

Sample Resources for Electronic Screening

Multiple tools in one systemChild H lth d D l t I t ti S t (CHADIS)Child Health and Development Interactive System (CHADIS)

Web-based diagnostic, management, and tracking tool www.childhealthcare.org/chadisOver 50 tools with linked decision support and resources (E-Textbook,Over 50 tools with linked decision support and resources (E Textbook, handouts, imported local referral sources)

Patient Tools System pediatrics.patienttools.comIntegrates with office systems to automate screening in the practice and at homeAssessment Library includes the most commonly used toolsCan be tailored to a particular practice’s needs

Si l t l il bl li (PEDS ASQ 3 CBCL)Single tools available online (PEDS, ASQ-3, CBCL)Individualization of Electronic Medical Records SystemsSystems

Topic 3: A Two-Stage Approach to Screening(Schor, Perrin, & Stancin, 2006)

Few: Comprehensive 

EvaluationEvaluation

Some:

2nd Stage

All: 

l tUniversal Screening 1st Stage

Universal First-Stage ScreeningBrief standardized measures administered on a routine basis to all children of a given age groupTypically addresses broad concerns (but can assess a singleTypically addresses broad concerns (but can assess a single dimension) Yields a cut-off point for behavioral health dysfunction relative to a normative standardnormative standardResults in further discussion, second-stage screening, or referral for a formal evaluation

1st Stage: Sample Broad Measures

MeasureAge Range

Time To Complete

Available Languages Source

Ages and Stages: Social‐ 6‐60  10‐15 English, Spanish www.brookespublishing.com

1 Stage: Sample Broad Measures

ges a d Stages: Soc aEmotional (ASQ:SE)

6 60Months

0 5Minutes

g s , Spa s .b oo espub s g.co(sample form on website)

Brief Infant‐Toddler Social and Emotional Assessment (BITSEA)

12‐36 Months

5‐7 Minutes English, Spanish http://harcourassessment.com

Parent Evaluation of 0 8 Years 5 Minutes English Spanish www pedstest comParent Evaluation of Developmental Status (PEDS)

0‐8 Years 5 Minutes English, Spanish, Vietnamese

www.pedstest.comOnline test at: www.Forepath.org

Pediatric Symptom Checklist(PSC)

4‐16 Months

5‐10 Minutes

English, Spanish, Japanese

http://psc.partners.org

Pediatric Symptom Checklist (PSC): A Commonly Used First-Stage ScreenC y U S g S

One-page questionnaire designed to identify emotional, behavioral, social, and cognitive concernsThree versions:

35-item parent-completed questionnaire for youth ages 4 to 16 years (PSC)y ( )

35-item self-report questionnaire for youth ages 11 to 18 (Y-PSC)

17-item, factor analyzed parent-completed questionnaire for th 4 t 16 (3 F t i t li i t li iyouth ages 4 to 16 years (3 Factors: internalizing; externalizing;

attention)Available in English, Spanish, Brazilian, European Portuguese, Chi Hi di d F h ll th lChinese, Hindi, and French, as well as other languages Access:

Longer parent version can be downloaded free of charge: http://psc partners org/psc order htmhttp://psc.partners.org/psc_order.htmYouth version: www.teenscreen.org

Pediatric Symptom Checklist: Short Parent Form (PSC-17)Short Parent Form (PSC 17)

Strategy: Use Single Domain Screening Toolsfor Selective First-Stage Screening

Screen universally at particular points in development for conditions of high prevalence:

o Se ec e s S age Sc ee g

development for conditions of high prevalence:

Age Condition

Infancy Maternal Depression

18 and 24 months Autism Spectrum Disorder18 and 24 months Autism Spectrum Disorder

30 to 60 months Early Disruptive Behavior Disorder

10 to 11 years Anxiety Disorder, Impulse Control Disorder

Adolescence Depression, Substance Abusep ,

Selective First-Stage Screening: Sample Single Dimension MeasuresSample Single Dimension Measures

1st Stage: Sample Single Dimension Measures

Measure Domain Age RangeTime to Complete Source

Edinburgh Postnatal Maternal Mothers 4 to 8 <5 Minutes

1st Stage: Sample Single Dimension Measures

Edinburgh Postnatal Depression Scale (EPDS)

MaternalDepression

Mothers 4 to 8 Weeks 

Postpartum(1st year of life)

<5 Minuteswww.brightfutures.org

Modified Checklist for 16‐48 Months www firstsigns org/downloads/m‐Modified Checklist for Autism in Toddlers (M‐CHAT)

Autism16 48 Months

5 Minuteswww.firstsigns.org/downloads/mchat_scoring.pdf and www.mchatscreen.com

Patient Health Questionnaire (PHQ‐9):

Adolescent Depression

12‐18 Years<5 Minutes www.phqscreeners.comQuestionnaire (PHQ 9): 

Modified for TeensDepression 5 Minutes www.phqscreeners.com

CRAFFT Test Substance Abuse

13‐20 Years 5 Minutes www.ceasar‐boston.org/clinicians/crafft.php

Second-Stage Screening

Two CategoriesMultidimensional ScalesMultidimensional Scales

Longer measuresAllow normative comparisons of severity of multiple psychosocial problems

2 d St S l B d M2nd Stage: Sample Broad Measures

MeasureAge Range

Time ToComplete

Available Languages Source

Achenbach System of Empirically Based Assessment (ASEBA)

18 Months to Adult

20 Minutes 74 Languages http://ASEBA.uvm.edu

Infant‐Toddler Social and Emotional Assessment (ITSEA)

12‐36 Months

30 Minutes English, Spanish

http://harcourtassessment.com

Single-Dimension ScalesMay be longer measuresProblem specificpExamples: Vanderbilt ADHD Diagnostic Scales, Modified Checklist for Autism in Toddlers, Patient Health Questionnaire (PHQ-9), CRAFFT

Sample Second-Stage Behavioral Health Screening ToolsScreening Tools

2nd Stage: Sample Single Dimension Measures

Measure Domain Age RangeTime to Complete Source

Vanderbilt ADHD Diagnostic Scales

ADHD 6‐12 Years 10 Minutes www.brightfutures.orgwww.vanderbiltchildrens.com

Self‐Report for Childhood Anxiety Related Emotional  Anxiety

8 + (Parent and Youth  5 Minutes

www.wpic.pitt.edu/researchy

Disorders (SCARED)y

Versions)

Modified Checklist for Autism in Toddlers (M‐CHAT)

Autism 16‐48 Months

5 Minutes www.firstsigns.org/downloads/m‐chat_scoring.pdf and www.mchatscreen.com

Children’s Depression Depression 7‐17 Years 10 Minutes www pearsonassessments com/tests/cdi htmChildren s Depression Inventory (CDI)

Depression 7‐17 Years 10 Minutes www.pearsonassessments.com/tests/cdi.htm

Patient Health Questionnaire (PHQ‐9): Modified for Teens

Adolescent Depression

12‐18 Years <5 Minutes www.phqscreeners.com

Modified for Teens

CRAFFT Test Substance Abuse

13‐20 Years 5 Minutes www.ceasar‐boston.org/clinicians/crafft.php

Suicidal Ideation Questionnaire (SIQ)

Suicide 13‐18 Years 10 Minutes www.parinc.comQuestionnaire (SIQ)

UCLA Post‐Traumatic Stress Disorder Reaction Index (UCLA PTSD RI)

Trauma7‐12 

(Parent/Child), 13+ (Youth)

20‐30 Minutes

© 2001 R.S. Pynoos, MD and A.M. Steinberg, PhD (Youth Version)© 2008 R.S. Pynoos, MD, A.M. Steinberg, PhD and M S Scheeringa MD

A Model for Providing Second-Stage Screening: The Psychologist’s Role

Mid-Level Assessment (Honigfeld et al., 2012)

• Falls between screening and evaluation

y g

Briefer and therefore less costly than traditional, more comprehensive services Uses second-stage screening measures to determine whether referral for a more extensive evaluation or intervention is warrantedCan be conducted on- or off-siteCan be conducted on or off site

Effectiveness of model relies on knowledge of local behavioral health resources to facilitate timely triage

Serves the system at-large by conserving the scarce, more intensive services for patients who need themmore intensive services for patients who need them

Promotes getting the right child to the right service at the right timethe right service at the right time

Role for Psychologists:

• Provide expedient and efficient mid‐level assessment services on‐or off‐site

Sample Risk Factor and Developmental Behavioral Health Screening ToolsBehavioral Health Screening Tools

Measure DomainTime to Complete Age Group Source

Sample Family and Social Environment Risk Factor Measures

p g p

Edinburgh Postnatal Depression Scale (EPDS)

Maternal Depression

<5 Minutes Mothers 4 to 8 Weeks Postpartum

www.brightfutures.org

McMaster General Functioning Scale

Family Functioning

5‐10 Minutes Parents of children Birth 15 Years

www.commondataelements.ninds.nih.gov/CRFs/Family%20Assessment%20DeviceFunctioning Scale Functioning Birth ‐ 15 Years

& Adolescentsv/CRFs/Family%20Assessment%20Device%20‐%20General

Parenting Stress Index™, Fourth Edition, Short Form (PSI™‐4‐SF)

Family Stress

10 Minutes Parents of children Birth – 12 Years

http://www4.parinc.com

Form (PSI 4 SF)

Sample Developmental Screening MeasureTime to 

Measure Domains Complete Age Group Source

Ages and Stages Questionnaire‐3 (ASQ)

MultipleDomains

10‐15 minutes

1 to 66 months(21 age levels)

www.brookspublishing.com

Resource for Additional Screening Tools:Addressing Mental Health Concern in Primary Care: A Clinician’s Toolkit (AAP, 2010) http://www2.aap.org/commpeds/dochs/mentalhealth/docs/MH-ScreeningChart.pdf

What can psychologists do?

Role for Psychologists:

• Develop a multidimensional Family and Social

Role for Psychologists:

Develop a multidimensional Family and Social Environment Risk screen with good psychometric properties

Topic 3: Establish Protocols for Response to Positive ScreensResponse to Positive Screens

Interpretation of a Positive Screen Interpret score as child “at risk”

Follow-Up ActivitiesDevelop a continuum of intervention options (Stein, Zitner, & Jensen, 2006)

Primary care-delivered psychosocial interventionsBehavioral health/developmental specialist or team based in primary careLinkage with specialty behavioral health services

Referral resource directoryCollaborati e relationshipsCollaborative relationships

Provide family with assistance to ensure that recommended follow-up services are securedEstablish a system for tracking progress over time for those childrenEstablish a system for tracking progress over time for those children identified by the screening as in need of follow-up services

Role for Psychologists:

• Facilitate development of tracking system to monitor screening results, assessment and treatment recommendations, compliance with recommendations, and outcome

Conclusion: Children and Youth Should Have Regular Mental Health Checkups

Screening for Behavioral Health Disorders in Pediatric Primary Care Constitutes Sound Medical Practice

g p

Primary Care Constitutes Sound Medical Practice

Behavioral health problems are worthy of screening on a universal and routine basis in pediatric primary carep p y(Glascoe, 2005; Schor, Perrin, & Stancin, 2006)

CommonImportantDecreased through early detection and subsequent interventionInexpensive, valid, and reliable measures available

Screening is a good use of resources:Screening is a good use of resources: “pay me now or pay me (more) later”

Take Home MessagesThe Opening of “Pandora’s Box” is Long Overdue

Psychologists are the ideal behavioral health professionals to collaborate with pediatric primar care to facilitate the implementation of ro tine screening forpediatric primary care to facilitate the implementation of routine screening for behavioral health concerns Psychologists must provide readily and seamlessly available collaborative

behavioral health services to increase the likelihood and efficacy of screeningbehavioral health services to increase the likelihood and efficacy of screening programsBeyond helping to institute screening programs, opportunities abound for

psychologists to partner with pediatric primary care to prevent, detect, and treat children’s behavioral health issues (Ward-Zimmerman & Cannata, in press)

Provide mid-level (second-stage) assessment services for identified children(on- or off-site)Provide on-site behavioral health treatment services Provide timely mental health specialty servicesProvide timely and regular communication to our pediatric partners (Foy & Perrin, 2010)

Now is the time to take action: C it li th i d f t it f t i ithCapitalize on the window of opportunity for partnering with

pediatric primary care opened by the patient-centered medical home and health care reform movements

Contact information:

Barbara Ward-Zimmerman, Ph.D.Barbara Ward Zimmerman, Ph.D.bward.zimmerman@cox.net

860-335-4466

Child Health and Development Institute of Connecticut, Inc.270 Farmington AvenueFarmington, CT 06032

Wheeler Clinic91 Northwest Drive91 Northwest Drive

Plainville, CT 06062

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D l M K C t ll E J C t ll A J Ed lb k C B t D & J i ki S (1990)Dulcan, M. K., Costello, E. J., Costello, A. J., Edelbrock, C., Brent, D., & Janiszewski, S. (1990). The pediatrician as gatekeeper to mental health care for children: Do parents’ concerns open the gate? Journal of American Academy of Child and Adolescent Psychiatry, 29(3), 453-458.

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Additional Resources:• American Academy of Pediatrics Mental Health Task Force

h // / d /d h / lh l hhttp://www.aap.org/commpeds/dochs/mentalhealth

• American Academy of Pediatrics Section on Developmental-Behavioral Pediatricshttp://www.dbpeds.org

• Bright Futures in Practice: Mental Health http://www.brightfutures.org/mentalhealth

C t f I t t d H lth S l ti f d d b Th S b t Ab d M t l H lth• Center for Integrated Health Solutions founded by The Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration http://www.integrationsamhsa.gov/about-us/webinars