TABLE 2

Steps to Implement Behavioral and Emotional Screening in Practice

1. Readying the practice
 • Describe and evaluate current efforts already in place
 • Identify a practice champion
 • Train all staff
 • Consider incremental screening and actively monitor implementation
 • Develop a screening roadmap from providing the screen through the referral process
 • Add behavior and emotional problems to the problem list and update this at each visit
 • Problem solve challenges that arise across the entire practice
 • Determine how to best publicize new screening practices to families
 • Consider additional costs for procuring screening tools, etc
 • Prepare for psychiatric emergencies that may present in the office
2. Identifying resources
 • Identify referral resources that include the following:
  • Areas of expertise
  • Hours of operation
  • Payment methods
  • Ability to treat non–English speakers
 • Develop a plan for bidirectional communication
 • Learn about emergency mental health services
 • Partner with adult providers and community resources to help parents with identified psychosocial risk
3. Establishing office routines for screening and surveillance
 • Implement screening in the first year of life and at regular intervals throughout childhood and adolescence
 • Incorporate screening for family psychosocial risks and strengths
 • Determine appropriate screening intervals for the practice (combined with or distinct from developmental screening intervals) based on things such as clinic flow, allotted time to discuss screening results, etc
 • Partner with parents to formulate a plan when there is a failed screen
 • Identify strengths of the child and communicate these to the family
 • Screen when the child, family, or provider has concerns
 • Establish a registry of children with positive screens and family psychosocial risk
 • Monitor children with significant risk factors with heightened surveillance and more frequent screening
4. Tracking referrals
 • Develop a mechanism to track progress of children referred for assessment or treatment (eg, successful referral, evaluation or initiation of treatment)
 • Collect information about families’ experience with referral resources
5. Seeking payment
 • Familiarize the practice with appropriate CPT codes for screening, care plan oversight, face-to-face and non–face-to-face services and reimbursement by different insurance companies
 • Track billing and reimbursement for screening efforts
6. Fostering collaboration
 • Explore colocated or other innovative models of care and partnerships with mental health professionals