1. Facilities or settings for screening and intervention should be available. Screening for risks or for precursors of MEB disorders is not limited by the availability of screening settings. Three settings appear to have particular advantages: (1) primary medical care, (2) schools, and (3) preschools or day care. However, none has become a site for the routine screening of children.

    Primary Care. A number of screening tools have been proposed for use in the medical office (Perrin and Stancin, 2002). One of the best indicators of risk for emergence of MEB disorders in the future is the presence of parental or caretaker concern about a particular child’s behavior. The office visit can screen for risk by routinely inquiring about parental concern. Computerized screening has demonstrated enhanced recognition of behavioral problems in the office setting (Stevens, Kelleher, et al., 2008). There are several barriers to widespread adoption of medical office screening for risks or behavioral indicators of future MEB disorder (Perrin and Stancin, 2002). First, most physicians, including pediatricians and their office staff, have not been trained to include screening in their routine well child or sick child visits (see Chapter 12). Second, good systems frequently are not in place to further assess children who are identified as being at risk. Many pediatric or family medicine offices are neither prepared to take necessary steps, nor are they linked to behavioral care capabilities (psychiatry, psychology, social work expertise) for follow-up of the screening outcomes. Third, in most medical office settings, neither public nor private payers will reimburse for behavioral screening. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), a Medicaid program, has been used largely to promote developmental screening. For a number of reasons, the intent of the program to include behavioral screening has not been fully realized; the EPSDT screening tools in nearly half the states do not address behavioral health issues at all (Semansky, Koyanagi, and Vandivort-Warren, 2003). States use a variety of tools with variable coverage of mental health and substance abuse issues (Judge David L. Bazelon Center for Mental Health Law, 2009). The state of Massachusetts, as the result of a court decision, has mandated behavioral screening for all children enrolled in Medicaid at each physician visit, starting in January 2008. Physicians’ practices are reimbursed $12 for each screening session, so compensation is not a barrier. The effectiveness of the screening and outcomes of children at risk in this program are as yet unmeasured.

    Assuring Better Child Health and Development (ABCD) is a program funded by the Commonwealth Fund and administered by the National Academy of State Health Policy. It has created two state health consortia, the second of which (ABCD II) employs standardized, validated screening tools to assess the mental development of young children and to provide follow-up services for those at risk. The successes of this program provide



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