QCDR Name: MBHR Mental and Behavioral Health Registry
| Measure Title | Screening and monitoring for psychosocial problems among children and youth |
| NQS Domain | Effective Clinical Care |
| Measure ID | MBHR5 |
| NQF ID | N/A |
| Measure Type | Patient Reported Outcome (PRO) |
| High Priority? | Yes |
| Description | Percentage of children from 3.00 to 17.99 years of age who are administered a parent-report, standardized and validated screening tool to assess broad-band psychosocial problems during an intake visit AND who demonstrated a reliable change in parent-reported problem behaviors 2 to 6 months after initial positive screen for externalizing and internalizing behavior problems. |
| Denominator | DENOMINATOR (SUBMISSION CRITERIA 1): Patients 3 to 17 years of age who are administered a parent-report, standardized screening tool.DENOMINATOR (SUBMISSION CRITERIA 2): i. Patients 3 to 17 years of age who are administered a parent-report version of the Pediatric Symptom Checklist Externalizing Subscale (PSC-ES) (score above 6 points) ii. Patients 3 to 17 years of age who are administered a parent-report version of the Pediatric Symptom Checklist Internalizing Subscale (PSC-IS) (score above 4 points)Denominator Exclusions: None Denominator Exclusions: None |
| Denominator Exceptions | Patients who present an acute condition or crisis during the intake visit who are not administered a behavior problem screener. |
| Numerator | NUMERATOR (SUBMISSION CRITERIA 1): Patients who were administered a psychiatric or behavioral health intake visit to assess broad-band psychosocial problems.NUMERATOR (SUBMISSION CRITERIA 2): i. Patients who were administered a psychiatric or behavioral health intake visit with a positive PSC-ES screening who demonstrated a reliable improvement of 2 or more points on parent-report version of the PSC-ES assessment taken 2 to 6 months later. ii. Patients who were administered a psychiatric or behavioral health intake visit with a positive PSC-IS screening who demonstrated a reliable improvement of 2 or more points on parent-report version of the PSC-IS assessment taken 2 to 6 months later Numerator Exclusions: None |
| Data Source | Claims, EHR, Paper Medical Record, Registry |
| Meaningful Measure Area | Functional Outcomes |
| Meaningful Measure Rationale | Screening for psychosocial problems in children and adolescents, one of the most common morbidities for children of this age, will promote interventions and best practices that are effective at reducing symptoms and improve functional status and quality of life by identifying and addressing appropriate treatment needs. This provides a standardized way to communicate status which will improve both quality of treatment and efficient use of resources. Using a standardized measure to assess psychosocial problems in children and adolescents will improve both quality of treatment and efficient use of resources. Measuring improved behavioral problems will promote interventions and best practices that are effective at reducing symptoms and improve functional status and quality of life. |
| Inverse Measure? | No |
| Proportional Measure? | Yes |
| Continuous Variable Measure? | No |
| Ratio Measure | No |
| Number of Performance Rates | 2 |
| Risk Adjusted | No |
| Preferred Specialty | mental and behavioral health |
| Applicable Specialties | Behavioral Health, Pediatrics, Family Medicine, Psychiatry |
Measure Justification
The broadband classifications of internalizing and externalizing behaviors1,2 represents one of most universally accepted and copiously cited diagnostic clusters used to characterize function of child and adolescent patient populations. This terminology has been the subject of study within a number of books and journal special issues, and the empirical robustness of these higher-order constructs received notice in the DSM-V as a useful framework for explaining common psychiatric comorbidities.3 In practice, these classifiers reflect widely applicable primary or secondary targets of most child and adolescent interventions and as such should appeal to a large swatch of mental and behavioral health practitioners. Alternative dimensional views of diagnostic classification usually include internalizing and externalizing behavior as two primary dimensions of psychosocial dysfunction,2,4-8 and through this lens, spectrums of I/E emotional and behavioral disorders routinely include oppositional defiant, conduct, attention-deficit/hyperactivity, substance use, antisocial personality, depressive, anxiety, somatic, obsessive-compulsive, and trauma and stress related disorders. With an estimated point prevalence falling somewhere between 11% and 20%, nationally,9-11 these childhood behavioral and emotional disorders are among the most common morbidities facing young people today, and these challenges extend far beyond the boundaries of behavior-specific diagnostic criteria to affect children exposed to a multitude of vulnerabilities known to increase I/E problem susceptibility like head injury,12 chronic illness,13 teratogen and toxin exposures,14,15 intellectual disabilities,16 child maltreatment,17,18 poverty,19,20 low socioeconomic levels,21 just to name a few. When untreated, I/E problems persist into adulthood,22 predict other future disorders and disabilities,23 and correspond with impaired, foundational social and emotional functioning that negatively impacts future relationships,24 physical health,25-27 mortality,28 academic achievement,29-31 work success,32 use of substances,33 and legal troubles.34,35 Because of the common co-occurrence of behavioral disorders and the broad range of vulnerabilities affecting I/E problems, an increasingly popular view suggests traditional, specialized therapeutic approaches to specific disorders will likely produce inferior quality of care when compared to treatments that focus on cross-cutting I/E targets.36-38
References
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