Objective

This study evaluates sequential screening to improve behavioral health needs detection, reduce unnecessary referrals, and discern adverse impacts (false negatives) for pediatric primary care populations.

Method

Monte Carlo simulation methodology was used to generate performance data for six sequential screening programs based on known technical properties of three broadband behavioral health measures and general psychopathology base rate estimates in pediatric primary care. Descriptive statistics, least-squares power regression, and data visualization were used to compare performance across programs.

Results

Ratio of reduced referrals to net false negatives was differentially affected by measure choice, administration order, and technical properties. Certain screening programs showed greater differences at lower base rates of psychopathology (approximately 12.8:1 ratio at 3% prevalence for SDQ-PSC [SDQ = Strengths and Difficulties Questionnaire, PSC = Pediatric Symptom Checklist] program), despite observed net sensitivity/specificity (0.47/0.97) that was comparable to other programs.

Conclusion

Sequential screening is a viable alternative to traditional single-measure behavioral health screening practices in primary care. However, stakeholders must be deliberate with instrument selection and implementation to maximize anticipated benefits and minimize costs. Closer examination of practical issues is necessary to further discern advantages of a screening workflow in pediatric primary care.

中文翻译：

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顺序筛查可改善初级保健中行为健康需求的检测

客观的

这项研究评估了序贯筛查，以改善对行为健康需求的检测，减少不必要的转诊以及辨别对儿科初级保健人群的不良影响（假阴性）。

方法

基于三种宽带行为健康措施的已知技术特性以及儿科初级保健中一般的心理病理学基本比率估计值，使用了蒙特卡罗模拟方法来生成六个顺序筛查程序的性能数据。描述性统计，最小二乘方幂回归和数据可视化用于比较各个程序的性能。

结果

减少推荐与净假阴性的比率受度量选择，管理顺序和技术属性的不同影响。尽管观察到净敏感性/特异性（尽管观察到的净敏感性/特异性（ 0.47 / 0.97），可以与其他程序媲美。

结论

在初级保健中，顺序筛查是传统的单项行为健康筛查实践的可行替代方案。但是，利益相关者必须认真考虑工具的选择和实施，以最大程度地提高预期收益并最小化成本。为了进一步发现儿科初级保健筛查工作流程的优势，有必要对实际问题进行仔细检查。