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 to 17 years of age who are receiving a psychiatric or behavioral health intake visit AND who demonstrated a reliable change in parent-reported problem behaviors 2 to 10 months after initial positive screen for externalizing and internalizing behavior problems. To see additional details, please view the workflow diagram for this measure: View diagram |
| Denominator | DENOMINATOR (SUBMISSION CRITERIA 1): All patient aged 3 to 17 years of age receiving a psychiatric or behavioral intake visit during the measurement period.Denominator Criteria (Eligible cases): Patients aged 3 to 17 years AND Patient encounter during the performance period (CPT): 0362T, 0373T, 90785, 90791, 90792, 90832,90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90875, 90876, 96110, 96112, 96113, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96156, 96158, 96159, 96164, 96165, 96167, 96170, 96171, 96178, 97129, 97130, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 98966, 98967, 98968, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215,99354, 99355, 99406, 99407, 99408, 99409, 99446, 99447, 99448, 99449, 99484, 99492, 99493, 99494, G2011, G2061, G2062, G2063, G0396, G0397, G0402, G0438, G0439 AND Patient has an Index PSC Score AND Patient has a follow up PSC Score DENOMINATOR (SUBMISSION CRITERIA 2): Denominator Criteria (Eligible cases): Denominator Exclusions: None INCLUDES TELEHEALTH: YES |
| 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 validated psychiatric screening to assess broad-band psychosocial problems .NUMERATOR (SUBMISSION CRITERIA 2): Patients who demonstrated a Response to Treatment as indicated by a positive improvement of 2 or more points on the PSC-ES or PSC-IS assessments taken 2 to 10 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 |
| Care Settings | Ambulatory Care: Hospital; Inpatient; Rehabilitation Facility; Nursing Home; Outpatient Services; Long Term Care |
Measure Justification
The broadband classifications of internalizing and externalizing behaviors [1,2] 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
1. Achenbach TM. The classification of children’s psychiatric symptoms: A factor-analytic study. Psychological Monographs: General and Applied. 1966;80(7):1-37.
2. Achenbach TM, Edelbrock CS. The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletin. 1978;85(6):1275-1301.
3. Achenbach TM. Future Directions for Clinical Research, Services, and Training: Evidence-Based Assessment Across Informants, Cultures, and Dimensional Hierarchies. Journal of Clinical Child & Adolescent Psychology. 2017;46(1):159-169.
4. Krueger RF. The structure of common mental disorders. Archives of General Psychiatry. 1999;56(10):921-926.
5. Krueger RF, Caspi A, Moffitt TE, Silva PA. The structure and stability of common mental disorders (DSM-III-R): A longitudinal-epidemiological study. Journal of Abnormal Psychology. 1998;107(2):216-227.
6. Vollebergh WM, Iedema J, Bijl RV, de Graaf R, Smit F, Ormel J. The structure and stability of common mental disorders: The nemesis study. Archives of General Psychiatry. 2001;58(6):597-603.
7. Krueger RF, Markon KE. Reinterpreting Comorbidity: A Model-Based Approach to Understanding and Classifying Psychopathology. Annual Review of Clinical Psychology. 2006;2(1):111-133.
8. Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the world health organization world mental health surveys. Archives of General Psychiatry. 2011;68(1):90-100.
9. Weitzman C, Wegner L. Promoting Optimal Development: Screening for Behavioral and Emotional Problems. Pediatrics. 2015.
10. US Department of Health and Human Services; US Department of Education; US Department of Justice. Report of the Surgeon General’s Conference on Children’s Mental Health: A national action agenda. Washington, D.C.: US Department of Health and Human Services; 2000.
11. Costello E, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry. 2003;60(8):837-844.
12. Gerring J, Vasa R. Head injury and externalizing behavior. In: Beauchaine TP, Hinshaw SP, eds. The Oxford Handbook of Externalizing Spectrum Disorders. New York, NY: Oxford University Press; 2015:403-415.
13. Pinquart M, Shen Y. Behavior Problems in Children and Adolescents With Chronic Physical Illness: A Meta-Analysis. Journal of Pediatric Psychology. 2011;36(9):1003-1016.
14. Liu J, Liu X, Wang W, et al. Blood lead levels and childrenÕs behavioral and emotional problems: A cohort study. JAMA Pediatrics. 2014;168(8):737-745.
15. Graham D, Glass L, Mattson S. Teratogen exposure and externalizing behavior. In: Beauchaine TP, Hinshaw SP, eds. The Oxford Handbook of Externalizing Spectrum Disorders. New York, NY: Oxford University Press; 2015:416-442.
16. Pinsonneault M, Parent S, Castellanos-Ryan N, Sguin J. Low intelligence and poor executive function as vulnerabilities to externalizing behavior. In: Beauchaine TP, Hinshaw SP, eds. The Oxford Handbook of Externalizing Spectrum Disorders. New York, NY: Oxford University Press; 2015:375-402.
17. Pears KC, Kim HK, Fisher PA. Psychosocial and cognitive functioning of children with specific profiles of maltreatment. Child Abuse & Neglect. 2008;32(10):958-971.
18. VanZomeren-Dohm A, Xu X, Thibodeau E, Cicchetti D. Child maltreatment and vulnerability to externalizing spectrum disorders. In: Beauchaine TP, Hinshaw SP, eds. The Oxford Handbook of Externalizing Spectrum Disorders. New York, NY: Oxford University Press; 2015:267-285.
19. Fitzsimons E, Goodman A, Kelly E, Smith JP. Poverty dynamics and parental mental health: Determinants of childhood mental health in the UK. Social Science & Medicine. 2017;175:43-51.
20. Mazza JRSE, Lambert J, Zunzunegui MV, Tremblay RE, Boivin M, Ct SM. Early adolescence behavior problems and timing of poverty during childhood: A comparison of lifecourse models. Social Science & Medicine. 2017;177:35-42.
21. Brooks-Gunn J, Duncan GJ, Britto PR. Are socioeconomic gradients for children similar to those for adults? Achievement and health of children in the United States. In: D. K, C. H, eds. Developmental Health and the Wealth of Nations: Social, Biological, and Educational Dynamics. New York, NY: Guilford Press; 1999:94Ð124.
22. Rutter M. Relationships between mental disorders in childhood and adulthood. Acta Psychiatrica Scandinavica. 1995;91(2):73-85.
23. Copeland WE, Shanahan L, Costello E, Angold A. Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry. 2009;66(7):764-772.
24. Pedersen S, Vitaro F, Barker ED, Borge AIH. The Timing of Middle-Childhood Peer Rejection and Friendship: Linking Early Behavior to Early-Adolescent Adjustment. Child Development. 2007;78(4):1037-1051.
25. Appleton AA, Buka SL, McCormick MC, et al. Emotional Functioning at Age 7 Years is Associated With C-Reactive Protein in Middle Adulthood. Psychosomatic Medicine. 2011;73(4):295-303.
26. Odgers CL, Caspi A, Broadbent JM, et al. Prediction of differential adult health burden by conduct problem subtypes in males. Archives of General Psychiatry. 2007;64(4):476-484.
27. Slopen N, Kubzansky LD, Koenen KC. Internalizing and externalizing behaviors predict elevated inflammatory markers in childhood. Psychoneuroendocrinology. 2013;38(12):2854-2862.
28. Jokela M, Ferrie J, Kivimki M. Childhood Problem Behaviors and Death by Midlife: The British National Child Development Study. Journal of the American Academy of Child & Adolescent Psychiatry. 2009;48(1):19-24.
29. Masten AS, Roisman GI, Long JD, et al. Developmental Cascades: Linking Academic Achievement and Externalizing and Internalizing Symptoms Over 20 Years. Developmental Psychology. 2005;41(5):733-746.
30. Malecki CK, Elliot SN. Children’s social behaviors as predictors of academic achievement: A longitudinal analysis. School Psychology Quarterly. 2002;17(1):1-23.
31. Duckworth K, Schoon I. Progress and attainment during primary school: the roles of literacy, numeracy and self-regulation. Longitudinal and Life Course Studies. 2010;1(3):18.
32. Kautz T, Heckman JJ, Diris R, Weel B, Borghans L. Fostering and Measuring Skills: Improving Cognitive and Non-cognitive Skills to Promote Lifetime Success. OECD Education Working Papers. 2014(110).
33. King SM, Iacono WG, McGue M. Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction. 2004;99(12):1548-1559.
34. Moffitt TE. Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review. 1993;100(4):674-701.
35. Mannuzza S, Klein R, Konig P, Giampino T. Hyperactive boys almost grown up: Iv. criminality and its relationship to psychiatric status. Archives of General Psychiatry. 1989;46(12):1073-1079.
36. Conrod PJ, Stewart SH. A Critical Look at Dual-Focused Cognitive-Behavioral Treatments for Comorbid Substance Use and Psychiatric Disorders: Strengths, Limitations, and Future Directions. Journal of Cognitive Psychotherapy. 2005;19(3):261-284.
37. Krueger RF, Markon KE. A dimensional-spectrum model of psychopathology: Progress and opportunities. Archives of General Psychiatry. 2011;68(1):10-11.
38. Chorpita BF, Reise S, Weisz JR, Grubbs K, Becker KD, Krull JL. Evaluation of the Brief Problem Checklist: Child and caregiver interviews to measure clinical progress. Journal of Consulting and Clinical Psychology. 2010;78(4):526-536.
The American Academy of Pediatrics (AAP)1 recommended the early identification of developmental disorders children citing it as an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals. Their policy statement provided an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children and recommended that developmental surveillance be incorporated at every well-child preventive care visit. Further, developmental screening is included in the AAP “Recommendations for Preventive Pediatric Health Care”2 or “periodicity schedule” and is further recommended by the two current AAP compilations of well-child care guidelines: Bright Futures3 and Guidelines for Health Supervision III.4 Children identified through screening may benefit from interventions in the primary care setting or community to address their symptoms or functional difficulties. They may also benefit from close monitoring of their emotional health by their families, pediatric health professionals, and teachers or caregivers.5
1. American Academy of Pediatrics Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental screening and surveillance. Pediatrics. 2006;118:405–420
2. American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine. Recommendations for preventive pediatric health care. Pediatrics. 2000;105:645– 646
3. Georgetown University, National Center for Education in Maternal and Child Health. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2nd ed. Washington, DC: Georgetown University; 2002
4. American Academy of Pediatrics. Guidelines for Health Supervision III. Elk Grove Village, IL: American Academy of Pediatrics; 1997 (updated 2002)
5. American Academy of Pediatrics. (nd). The Mental Health Screening and Assessment Tools for Primary Care. Downloaded from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Documents/MH_ScreeningChart.pdf