Papers by MICHAEL JELLINEK
Psychological Disorders and Research, 2020
Objective: This study explored site-level rates of behavioural health (BH) screening, positive sc... more Objective: This study explored site-level rates of behavioural health (BH) screening, positive screening, and BH service use in statewide data from the largest Medicaid Health Maintenance Organization in Massachusetts. Methods: Screening rates at annual well-child visits (WCVs) were assessed across 908 sites (practices) for patients ages 4-17 between 2014-2018. The primary analytic sample included WCVs in 2016 (N=76,752) and was restricted to sites with at least 30 WCVs (N=304 sites; N=72,842 patients). Use of BH services was assessed six months before and after the index WCV. Results: The mean WCV screening rate across the analytical sample was 71.2% (SD=31.3; range=0.0- 100.0%) and the mean positive screening rate was 7.2% (SD=12.7, range=0-100%). Using intra-class correlations, small, but meaningful differences, were found between sites in rates of overall (r=0.38; 95% CI=0.25-0.50) and positive (r=0.10; 95% CI=0.00-0.29) screening. Although the relationship between a site’s rate...
Academic Pediatrics, 2019
Background and Objectives: The study's goal was to measure the association between social risks a... more Background and Objectives: The study's goal was to measure the association between social risks and the mental health of school-age children in primary care. Methods: We conducted a cross-sectional study in an urban safety-net hospital-based pediatric clinic using data collected from two standard screening tools administered at well child care visits for children age 6-11. Psychosocial dysfunction was measured with the Pediatric Symptom Checklist-17 (PSC-17) and six social risks (caregiver education, employment, child care, housing, food security, and household heat) were measured with the WE CARE screener. Multivariable
Clinical pediatrics, 2018
We tested the accuracy of 2 parent-report tools, the Pediatric Symptom Checklist (PSC-35) and Chi... more We tested the accuracy of 2 parent-report tools, the Pediatric Symptom Checklist (PSC-35) and Child Behavior Checklist (CBCL), to identify attention-deficit/hyperactivity disorder (ADHD) and distinguish complex (highly comorbid) cases in an urban, largely Latino pediatric practice. Spanish- and English-speaking parents of children aged 6 to 10 years completed a PSC-35 and CBCL at well visits. Those with CBCL Attention Problems Subscale (CBCL-APS) T scores ≥60 plus controls completed the diagnostic MINI-KID (Miniature International Neuropsychiatric Interview) for Children. Receiver operating characteristic (ROC) curves quantified accuracy of both scales to distinguish ADHD from non-ADHD, and complex from simple ADHD. Two hundred and nine children were screened, and 41 completed diagnostic interviews. Both the CBCL-APS and PSC Attention Scale (PSC-AS) accurately identified ADHD; the CBCL-APS performed best (AUROC = 0.837; AUROC = 0.728). The PSC Total and Internalizing Scores and the ...
JAMA, 2016
Should trustees, including those serving on boards of nonprofit hospitals, physician organization... more Should trustees, including those serving on boards of nonprofit hospitals, physician organizations, and nonprofit health care organizations, consider every opportunity to transition from fee-for-service reimbursement to population health management and accept financial risk related to possible decreases in the volume of care patients seek at their institutions? For the purposes of this Viewpoint, population health management is a set of activities focused on a defined population that improves quality and outcomes while lowering the total costs of care and is substantially incentivized through contracts that accept financial risk and gain. From 2013 to 2014, health care expenditures increased 5.3%, substantially above the rate of inflation, and equaled 17.5% of all goods and services produced in the United States.1 Fee-for-service reimbursement results in cost increases by encouraging patient use of medical services. The majority of trustees appreciate that the revenue from fee-for-service is essential to keeping their institution financially sustainable. Rather than rewarding use of services, most physicians, other health professionals, and health care organizations involved in population health management are incentivized to collaborate and create value
Harvard review of psychiatry, Jan 5, 2017
Untreated mental health problems are among the most disabling, persistent, and costly health cond... more Untreated mental health problems are among the most disabling, persistent, and costly health conditions. Because they often begin in childhood and continue into adulthood, there has been growing interest in preventive mental health programs for children. In recent years, several such programs have been implemented at regional, state, or national scale, and although many experimental studies have documented positive outcomes of individual programs, this article represents the first attempt to systematically compare the largest programs in terms of scope, scale, and dose. The school-based mental health programs discussed in this review appear to have reached more than 27 million children over the last decade, and many of these programs have collected systematic outcomes data. The role that such programs can play in low- and middle-income countries (LMICs) is a secondary focus of this article. Until recently, wide-scaled, preventive, mental health interventions for children have been s...
Academic pediatrics, 2017
To examine the prevalence of positive screening scores, construct validity, and opportunities for... more To examine the prevalence of positive screening scores, construct validity, and opportunities for follow up in a large sample of adolescents who chose to fill out the Pediatric Symptom Checklist - Youth Form (PSC-Y) through the Mental Health America (MHA) website. MHA sent researchers a de-identified dataset of all PSC-Y's submitted to MHA from May 15, 2015 to May 14, 2016. The analytic dataset contained 29,886 PSC-Y forms from youth aged 11-17 who sought out the website and chose to fill out the PSC-Y anonymously and independently online. The prevalence of impairment on the PSC-Y was calculated overall and for various subgroups. Next steps reported by at-risk youth were also examined. 77.4% of youth screened positive on the PSC-Y. Significant associations between positive screening and self-ratings of a need for help, previous history of mental health treatment, and low family income provided construct validation for the online PSC-Y. Almost two-thirds of positively screened yo...
Pediatrics, Sep 12, 2016
The Pediatric Symptom Checklist-17 (PSC-17) is a widely used, briefer version of the PSC-35, a pa... more The Pediatric Symptom Checklist-17 (PSC-17) is a widely used, briefer version of the PSC-35, a parent-completed measure of children's psychosocial functioning. Despite the extensive use of the PSC-17 over the past 15 years there has not been a large-scale replication of the original derivation study. To examine the prevalence of positive screens, reliability, and factor structure of PSC-17 scores in a new national sample and compare them with the derivation sample. Data were collected on 80 680 pediatric outpatients, ages 4 to 15 years, whose parents filled out the PSC-17 from 2006 to 2015 via the Child Health and Development Interactive System, an electronic system that presents and scores clinical measures. The rates of positive screening on the overall PSC-17 (11.6%) and on the internalizing (10.4%) and attention (9.1%) subscales were comparable to rates found in the original sample, although the rate of externalizing problems (10.2%) was lower than in the derivation study. R...
Gezinstherapie Wereldwijd, 2016
Journal of Ambulatory Care Management, 2005
The Massachusetts General Hospital developed a series of space and utilization guidelines that as... more The Massachusetts General Hospital developed a series of space and utilization guidelines that assisted in the planning of a 450,000-ft 2 ambulatory care facility. The guidelines attempted to balance and preserve the critical elements of the hospital's culture while, at the same time, create a highly efficient ambulatory care building. This article discusses the economic, political, and cultural implications of implementing specific project principles and guidelines known as the "9 Commandments.
Journal of The American Academy of Child and Adolescent Psychiatry, 1998
Clinical Psychiatry News, 2011
The Hastings Center Report, 1976
Advances in dermatology, 1989
Adolescence is characterized by a sensitivity to issues of attractiveness, emerging sexuality, an... more Adolescence is characterized by a sensitivity to issues of attractiveness, emerging sexuality, and the challenge of parental rules and values. The latter tends to carry over into the relationship with other authority figures like the dermatologist. Noncompliance is a significant problem in treating this age group. It can be decreased by establishing an alliance with the patient concerning the goals of therapy. Although the parent may have brought in the teenager, the success of treatment depends on the patient himself or herself. The adolescent is most likely to follow through if the dermatologist presents the pros and cons of the treatment and explicitly leaves the choice of implementation to the adolescent. Parents who confidently offer to make sure the adolescent follows the treatment plan may only increase noncompliance by placing the treatment in the middle of existing parent-child struggles. For a variety of reasons, adolescents are hesitant to ask questions of the dermatologi...
Pediatrics, 2013
To review recent health policies related to measuring child health care quality, the selection pr... more To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace.
Child psychiatry and human development, Jan 5, 2014
The Pediatric Symptom Checklist (PSC) is a widely-used, parent-completed measure of children'... more The Pediatric Symptom Checklist (PSC) is a widely-used, parent-completed measure of children's emotional and behavioral functioning. Previous research has shown that the PSC and its subscales are generally responsive to patient progress over the course of psychiatric treatment. In this naturalistic study, we examined the performance and utility of the five-item PSC Internalizing Subscale (PSC-IS) as an assessment of routine treatment in outpatient pediatric psychiatry. Parents and clinicians of 1,593 patients aged 17 or younger completed standardized measures at intake and three-month follow-up appointments. Comparisons between PSC-IS scores and clinician-reported diagnoses, internalizing symptoms, and overall functioning showed acceptable levels of agreement. Change scores on the PSC-IS were also larger among patients with internalizing diagnoses than those with non-internalizing diagnoses. As a brief measure of internalizing symptoms, the PSC may be particularly useful to ment...
Pediatric Dermatology, 1986
ABSTRACT
Journal of the American Academy of Child & Adolescent Psychiatry, 1999
The Journal of Pediatrics, 1979
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Papers by MICHAEL JELLINEK