Linking universal developmental/behavioral health screening and on-site mental health consultation: Examining gaps in service delivery

Universal screening and on-site mental health consultant (MHC) support within pediatric primary care settings may improve problem identification and service receipt, thus reducing children's unmet developmental and behavioral health (DBH) needs. However, there is limited research about universal DBH screening and on-site MHC support in pediatric settings. The overarching aim of this mixed-method study was to describe the effectiveness and characteristics of a model that placed MHCs in primary care pediatric settings to facilitate universal DBH screening and referrals. The investigation was conducted within the framework of Project RI LAUNCH (Linking Actions for Unmet Needs in Children's Health), a study involving the integration of universal screening and on-site MHC support into pediatric practices in Providence, RI. Quantitative aims were focused on describing: 1) the effectiveness of universal screening, 2) the profile of DBH problems and parent concerns identified during screening; 3) referral dispositions following screening; and 4) predictors of attendance at the MHC appointment. Qualitative aims were focused on better understanding screening and collaborative care from the perspective of parents, staff, and providers. Parents of children less than 9 years with a scheduled screen-eligible visit (1,451) were included in the quantitative sample. Interviews were conducted with 16 parents and 29 staff members. Findings suggest that integrating universal DBH screening and MHC support is feasible and can improve problem detection. Yet despite the benefits, findings suggest several gaps in service delivery. Due to a variety of reasons, many families do not receive/complete screening nor attend MHC appointments. While parental DBH concerns are often well founded, there are limitations in the extent to which parental concerns should be relied on as a proxy for child behavior, particularly for younger children. Young children were found to be at increased risk of falling through service delivery gaps compared with older children given that their parents were less likely to report behavioral concerns (even when screening indicated the presence of problems), providers referred them to MHCs at lower rates and, among those referred, were less likely to attend these appointments. Recommendations include decreased screener length and increased information for parents about DBH, screening, and referrals.