Behavioral Health Screening in Pediatric Preventive CareThe HUSKY Health Approach

Robert W. Zavoski, MD, MPHMedical Director,

CT Department of Social Services

Connecticut Medicaid - Overview

• Enrollees:– 668,000 (17% of total population)– 449,000 in family coverage (1 in 4 Connecticut

children, 40% of all CT births)• Model of care – “managed fee for service” via

administrative service organizations (ASOs)– Behavioral Health Partnership - children (2007),

adults (2011)– Dental Health Partnership – 2009– Medical ASO - 2012

Screening in HUSKY Health

• Early Periodic Screening Diagnostic Testing (EPSDT)

• Developmental Screening (2008)• Person-Centered Medical Home (2012)• Intensive Care Management (2012)

Developmental and Behavioral Screening in Health Supervision

• Recommended by the American Academy of Pediatrics and the National Clearing House with use of validated tools– AAP.org/Bright Futures site lists and describes

recommended tools• AAP also recommends ‘surveillance’ – routine

assessments of risks and progress, as well as promotion of resilience

Rationale for Screening

• Developmental disabilities are common• Disabilities can be ameliorated or successfully

treated• Screening and counseling can be easily

included in a routine preventive health visit• Many tools are either parent or patient self-

administered

Provisos to the Rationale for Screening

• “Easy” isn’t that easy• Development and Behavior are used together– Research to support routine developmental

screening in young children is strong– Research to support routine behavioral screening or

surveillance at any age is sparse– U.S. Preventive Health Services Task Force:

• routine developmental screening - I rating• routine autism screening – no recommendation• specific behavioral screening – variable recommendations

HUSKY Health – next steps

• Medical/behavioral Health integration• Health homes with DMHAS for those with

serious and persistent mental illness• Routine universal behavioral screening for all

under EPSDT

Questions?

• Robert Zavoski, MD, MPH• Medical Director

• CT Department of Social Services• robert.zavoski@ct.gov