514 - PSC-17 Screening Results and Associated Behavioral Health Diagnoses within 9-Year Pediatric Well Visits

Publication Number: 4504.514

Nhi Lang, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Jamie Catalano, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Jennifer Xu, Childrens Hospital of Philadelphia, Philadelphia, NC, United States; Lauren White, Children's Hospital of Philadelphia/Penn Medicine, Philadelphia, PA, United States; Jennifer A.. Mautone, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Barbara Chaiyachati, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Recommendations regarding pediatric behavioral health (BH) have evolved to include routine screening in primary care to support early identification. The Pediatric Symptom Checklist-17 (PSC-17) is a tool for identifying psychosocial concerns. Early outcomes in routine screening implementation may support effective implementation.

Objective: To describe the prevalence of PSC-17 positive screens and associated diagnoses.

Design/Methods: We analyzed electronic health record (EHR) data from primary care clinics within a large hospital-affiliated network. This study was determined exempt by the CHOP IRB. The study included records (n = 20,028) with completed PSC-17 during 9-year well-child visits (WCV; ages 8.5-9.5yrs) between August 1, 2023, and March 1, 2025, following routine screener implementation. We assessed the prevalence of International Classification of Diseases (ICD) F-code diagnoses during the six-month period before and after the WCV in which PSC-17 screening was completed. Plots were generated to depict the prevalence of F-code diagnoses within the six months preceding screening, grouped by overall and subscale symptom scores. Logistic regression models were used to evaluate for an association of screening results with new F-code diagnoses in 6 months after WCV, accounting for clinic-level presence of integrated behavioral health (IBH; no/yes). Regression models excluded those without an opportunity for a new relevant diagnosis (e.g., already had an ADHD diagnosis preceding elevated attention score).

Results: By the Overall threshold, 2,098 (10.5%) PSC-17 screens were positive. As symptom scores increased, there was a higher prevalence of recently documented BH diagnoses. Scores at or above the Overall threshold were associated with 4-fold higher odds of new F-code diagnoses (OR 4.50, 95% CI 3.69-5.48, p < .001). Subscale F-code associations were also significant: Attention (ADHD, OR 15.35, 95% CI 11.42-20.64), Externalizing (ADHD/conduct disorder, OR 5.21, 95% CI 3.81-7.12), and Internalizing (Anxiety, OR 7.40, 95% CI 5.47-10.03). IBH independently increased the odds of new diagnoses within Overall (OR 1.36, 95% CI 1.21-1.53), Attention (OR 1.44, 95% CI 1.13-1.85), and Externalizing (OR 1.44, 95% CI 1.20-1.73) models. There was no interaction between screen results at or above threshold and presence of IBH.

Conclusion(s): PSC-17 screening during well-child visits identified a high burden of BH concerns. Screens at or above threshold scores were strongly associated with new diagnoses, and IBH presence enhanced detection further, providing support for co-located services in pediatric primary care.

Table 1. Cohort description of children with completed PSC-17 and positive results.
Race and ethnicity of patient (child) as recorded in medical record demographics. * Insurance type options included private, Medicaid and self-pay. ** PSC-17 thresholds: Overall (OVR): ≥15, Attention (ATT): ≥7, Externalizing (EXT): ≥7, Internalizing (INT): ≥5. Abbreviations: AIAN: American Indian or Alaska Native, Af.Am.: African American, IBH: Integrated behavioral health available (eg: Healthy Minds Healthy Kids at clinic level), NHOPI: Native Hawaiian or Other Pacific Islander. NH/NL: Non-Hispanic or Non-Latino.

Table 2. Association between PSC-17 results and new F-code diagnosis within 6 months.
Cohort restricted to patients who completed visit at least six months prior to end of study period and opportunity for new relevant diagnosis. Patients who received a diagnosis prior to PSC-17 completion cannot be included for the same subscale score when evaluating a new, relevant diagnosis. PSC-17 results scored as positive/negative and IBH coded at clinic level (0, no; 1, yes) without restriction to individual contact. Overall PSC-17 result related to any new F-code diagnosis in the EMR; subscales (attention, externalizing, internalizing) restricted to domain specific diagnoses (attention, F90 ADHD; externalizing, F90 ADHD, F91 conduct; internalizing, F41 anxiety). Logistic regression controlled for sex (0, Female; 1, Male) and insurance (0, Public, 1, Private) with odds ratio, 95% Confidence Interval and p value reported.

Figure 1. Pre-existing behavioral health diagnoses within the EMR by domain specific PSC-17 subscales.
Diagnoses within six months preceding PSC-17 completion. Thresholds for positive OVR (≥ 15) and subscales depicted with vertical lines (ATT and EXT: ≥ 7; INT ≥ 5). Data depicted for PSC-17 symptom scores with at least 130 occurrences. Any ICD-10 F-code diagnosis included for overall (OVR); domain-specific diagnoses depicted for subscales (attention [ATT], F90 ADHD; externalizing [EXT], F90 ADHD, F91 conduct; internalizing [INT], F41 anxiety).