Screening for Behavioral Health Issues in Primary Care

Abstract

Over the past several decades, pediatricians and other primary care providers have recognized the need for greater implementation of screening for emotional and behavioral health (BH) problems, yet only a minority screen for BH issues. We summarized guidelines from Bright Futures/American Academy of Pediatrics (AAP), the US Preventive Services Task Force (USPSTF), and the AAP Task Force on Mental Health (TFOMH) regarding screening for BH disorders in the pediatric primary care setting. We provide information on validated screening tools that a pediatrician might use in practice, listed by age range. We also present the recent literature on screening for behavioral health issues in primary care focusing on screening initiatives and their impact, models of screening, feasibility, and clinician and caregiver attitudes. We recommend that pediatricians develop a process to implement general BH screening, as well as targeted screening for specific disorders, according to the guidelines. Although initiatives have resulted in increased screening, children are still missed. Initiatives are variable in how they report clinical outcomes with many but not all reporting increases in identification and referral. More research is needed on how to best implement BH screening in primary care and how to ensure that it positively impacts BH assessment and treatment in primary and BH specialty care.