Sequential Screening to Improve Behavioral Health Needs Detection in Primary Care. J Am Acad Child Adolesc Psychiatry 2018 Aug;57(8):603-609
Date
08/04/2018Pubmed ID
30071981DOI
10.1016/j.jaac.2018.04.017Scopus ID
2-s2.0-85050667664 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
OBJECTIVE: This study evaluates sequential screening to improve behavioral health needs detection, reduce unnecessary referrals, and discern adverse impacts (false negatives) for pediatric primary care populations.
METHOD: Monte Carlo simulation methodology was used to generate performance data for six sequential screening programs based on known technical properties of three broadband behavioral health measures and general psychopathology base rate estimates in pediatric primary care. Descriptive statistics, least-squares power regression, and data visualization were used to compare performance across programs.
RESULTS: Ratio of reduced referrals to net false negatives was differentially affected by measure choice, administration order, and technical properties. Certain screening programs showed greater differences at lower base rates of psychopathology (approximately 12.8:1 ratio at 3% prevalence for SDQ-PSC [SDQ = Strengths and Difficulties Questionnaire, PSC = Pediatric Symptom Checklist] program), despite observed net sensitivity/specificity (0.47/0.97) that was comparable to other programs.
CONCLUSION: Sequential screening is a viable alternative to traditional single-measure behavioral health screening practices in primary care. However, stakeholders must be deliberate with instrument selection and implementation to maximize anticipated benefits and minimize costs. Closer examination of practical issues is necessary to further discern advantages of a screening workflow in pediatric primary care.
Author List
Young ND, Takala CRAuthor
Nicholas D. Young PhD Assistant Professor in the Orthopaedic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Health Services Needs and DemandHumans
Mass Screening
Mental Health Services
Primary Health Care
Psychiatry
Sensitivity and Specificity
Surveys and Questionnaires
