(PS7-D97) Integrating Early Childhood Screening into the Electronic Health Record: A Mechanism for Improving Access to Evidence-based Care

Nearly one in five youth in the US experiences a mental health disorder, with early developmental and behavioral patterns often emerging within the first years of life. Early childhood psychosocial interventions have the potential to result in profound and lasting treatment effects during a period of significant neuroplasticity. While early identification and intervention are vital to promoting optimal outcomes, most children who need these services do not receive them, with reduced access for children from racial and ethnic minority groups. One strategy for increasing timely identification and access to services is to embed systematic screening into annual well-child visits in pediatric primary care.

Consistent with ABCT’s 57^th Annual Convention theme, Building Early Connections (BEC), a behavioral health program at Rush University Medical Center serving children ages 8 and under, sought to improve access to evidence-based care through the integration of social-emotional, behavioral, and developmental (SE/B/D) screening into the electronic health record (EHR). The objective was to capitalize on technological advances in automation to decrease the screening burden on pediatricians and patients, improve screen rates, and increase the likelihood of early identification and referral to appropriate services for intervention (i.e., the BEC clinical team and/or Early Intervention through Illinois). The Survey of Wellbeing of Young Children (SWYC; Perrin et al., 2016), which screens children through age 5 for SE/B/D concerns, was chosen for use, as it is well-validated, free, and built to be compatible with EHR systems.

BEC worked closely with pediatric partners and the medical informatics team to ensure that SWYC screening administration, scoring, documentation, and referral guidance were incorporated into the EHR, resulting in easier and more efficient workflows on the patient- and provider-facing sides. Examples of technical integration included: creating access to the SWYC in a patient portal to be completed prior to appointment check-in; automating age-specific forms in the EHR, such that caregivers completed the appropriate screener for their child’s development; automatic scoring and population of scores into age-specific note templates for providers; and highlighting positive/concerning scores in red, with a “best practice alert” to nudge the provider toward a behavioral health referral.

During the period of data collection (July 2020-September 2022), 18,244 screens were administered; 2,345 referrals were made to the BEC clinical team, and 1,486 referrals were made to Early Intervention; and 1,257 families received evidence-based care through BEC (e.g., behavioral parent training, parent-mediated CBT, psychoeducation). Embedded screening has been adopted by five pediatric clinics in the hospital system. Due to the successful automation of the SWYC, the Pediatric Symptom Checklist-17 (PSC-17; Gardner & Kelleher, 1999) has been integrated into the EHR since November 2022 for use in screening for psychosocial concerns in children ages 6 through 8. Comprehensive data, including both SWYC and PSC-17 screening rates, will be available for presentation at the ABCT 2023 convention.