1. Behavioral Health Screening in Pediatric Preventive Care The HUSKY Health Approach Robert W. Zavoski, MD, MPH Medical Director, CT Department of Social Services

2. 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

3. Screening in HUSKY Health Early Periodic Screening Diagnostic Testing (EPSDT) Developmental Screening (2008) Person-Centered Medical Home (2012) Intensive Care Management (2012)

4. 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

5. 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

6. 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

7. 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

8. Questions? Robert Zavoski, MD, MPH Medical Director CT Department of Social Services robert.zavoski@ct.gov