Feasibility of a network-wide implementation of psychosocial screening in pediatric primary care

Juliana M. Holcomb, BA

Massachusetts General Hospital
Feasibility of a network-wide implementation of psychosocial screening in pediatric primary care

Scientific Abstract


Background: To improve compliance with psychosocial screening quality standards for well-child visits (WCVs), a network of 8 pediatric practices in Massachusetts programmed the Baby Pediatric Symptom Checklist (BPSC), the Preschool Pediatric Symptom Checklist (PPSC) and the Pediatric Symptom Checklist-17 (PSC-17) for children ages 2 months-1.4 years-old, 1.5-4.9 years-old, and 5.0-17.9 years- old, respectively, into the electronic health record (EHR). This study analyzed differences in screening rates by age group, insurance, and practice in 2019, the most recent full year of the program.

Methods: As billing for screens is a state requirement for children with Medicaid insurance, evidence of a bill for a screen or an actual screen found in the EHR was taken as proof of screening. Parents completed screens electronically or on paper. Data were reviewed for all patients 2.0 months to 17.9- years-old who had a WCV in 2019.

Results: Of 22,112 patients with a WCV in 2019, 16,475 (74.5%) were screened. Within the 16,475 screened patients, 2,389 were 2.0 months – 1.4 years, 3,123 were 1.5 – 4.9 years, and 10,963 were 5.9 – 17.9 years old. Screening rates differed significantly by age group (69.4% [BPSC] vs. 71.9% [PPSC] vs. 76.5% [PSC], χ2[2]=94.03, p<.001) and by insurance type, with significantly higher screening rates in Medicaid-insured youth compared to commercially-insured youth (81.7% vs. 65.5%, χ2[1]=738.84, p<.001). The 8 clinics differed significantly in screening rates (range: 30.1-96.5%, χ2[6]=9056.31, p<.001). Qualitative chart reviews revealed disparities in screen format by clinic, with some predominantly using electronic screening methods and others using paper-and-pencil.

Conclusions: The current study demonstrated the feasibility of implementing psychosocial screening for children ages 2 months-17.9-years-old in a network of 8 pediatric clinics. Although screening rates were somewhat lower in younger age groups and commercially insured youth compared to their respective counterparts, this study demonstrates that screening babies and toddlers as well as youth with commercial as well as Medicaid insurance in pediatric primary care is feasible.

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research Areas


Juliana M. Holcomb, BA, Anamika Dutta, BA, Radley Christopher Sheldrick, PhD, Alexa Riobueno-Naylor, BA, Dina Hirshfeld-Becker, PhD, Alice S. Carter, PhD, Ellen C. Perrin, MD, Michael S. Jellinek, MD, J. Michael Murphy, EdD

Principal Investigator

Michael S. Jellinek, MD, J. Michael Murphy, EdD