Objective: To examine pediatricians time spent, and resulting reimbursement payments for, address... more Objective: To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. Methods: Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22 % of patient visits, was ≥90%. Results: Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. Conclusion: Findings...
While researchers have attempted to address the difficulties of diagnosing affective disorders in... more While researchers have attempted to address the difficulties of diagnosing affective disorders in the intellectually disabled population, diagnosing bipolar disorder in an individual with severe intellectual disability (ID) remains a challenge. The aim of this study was to identify what symptoms can predict a diagnosis of mania in the intellectually disabled population. Three groups of persons with ID participated in this study: (1) individuals with a bipolar diagnosis who were currently manic; (2) individuals with an Axis I diagnosis other than bipolar disorder; and (3) individuals without an Axis I diagnosis. Two recognized measures of mania (i.e. Diagnostic Assessment for the Severely Handicapped-Revised and Parent Version of Young Mania Rating Scale) were used to evaluate symptoms of mania. A logistical regression procedure was conducted on mania items to identify which items correctly identify persons with ID who were currently manic. Psychomotor agitation, decreased sleep, changes in mood and aggression were significantly related to the diagnosis of mania. Further, psychomotor agitation and disturbed sleep were significant predictors of a diagnosis of mania. Problems of sleep and psychomotor agitation should alert clinicians that further assessment of bipolar symptomatology is warranted. Focusing on observable behaviours based on Diagnostic and Statistical Manual of Mental Disorder-IV criteria can be useful in formulating a diagnosis of bipolar disorder in persons with ID.
Journal of Intellectual and Developmental Disability, 2008
Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledg... more Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledge of how schizophrenia spectrum disorders (SSD) manifest themselves in individuals with intellectual disability (ID). In addition, little is known about the relationship between behaviour problems and psychopathology in this population. Utilising the Behavior Problems Inventory (BPI), three areas of problem behaviour (self-injurious, stereotyped, and aggressive/destructive) were assessed in 58 individuals with ID divided into three groups (with SSD, with a diagnosis of psychopathology other than SSD, and with ID only) and a total BPI score was calculated for each. The SSD group was unique when compared to the Control group (ID only) for frequency of stereotyped behaviours. Further, severity of stereotyped behaviours in the SSD group was unique compared to the Psychopathology and Control groups. The SSD group was unique compared to the other two groups, particularly for severity of stereotyped behaviours. Many specific behavioural differences were also related to either SSD or general psychopathology.
Journal of Developmental & Behavioral Pediatrics, 2013
The purpose of the study was to examine how access factors affect prescribing practices of psycho... more The purpose of the study was to examine how access factors affect prescribing practices of psychotropic medications among pediatricians. More specifically, the aim of the current study was to examine differences in the treatment of mental and behavioral health problems among children and adolescents across small nonmetropolitan, regional, metropolitan, and urban settings across the United States. A total of 516 pediatricians working in outpatient clinics located in 12 US states, 3 in each of the following regions: New England, the Plains, the Pacific Northwest, and the South completed surveys on their prescription practices for children and adolescents with mental and behavioral health needs. Findings indicate that pediatricians in small nonmetropolitan settings with populations of fewer than 20,000 prescribe antidepressants; antianxiety, antipanic, and antiobsessive medication; antipsychotics; and mood stabilizers significantly more frequently than their counterparts in urban, metropolitan, and regional settings. Implications of these findings for clinical practice and training are discussed.
To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavio... more To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22% of patient visits, was ≥90%. Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement.
Objective: To examine pediatricians time spent, and resulting reimbursement payments for, address... more Objective: To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. Methods: Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22 % of patient visits, was ≥90%. Results: Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. Conclusion: Findings...
While researchers have attempted to address the difficulties of diagnosing affective disorders in... more While researchers have attempted to address the difficulties of diagnosing affective disorders in the intellectually disabled population, diagnosing bipolar disorder in an individual with severe intellectual disability (ID) remains a challenge. The aim of this study was to identify what symptoms can predict a diagnosis of mania in the intellectually disabled population. Three groups of persons with ID participated in this study: (1) individuals with a bipolar diagnosis who were currently manic; (2) individuals with an Axis I diagnosis other than bipolar disorder; and (3) individuals without an Axis I diagnosis. Two recognized measures of mania (i.e. Diagnostic Assessment for the Severely Handicapped-Revised and Parent Version of Young Mania Rating Scale) were used to evaluate symptoms of mania. A logistical regression procedure was conducted on mania items to identify which items correctly identify persons with ID who were currently manic. Psychomotor agitation, decreased sleep, changes in mood and aggression were significantly related to the diagnosis of mania. Further, psychomotor agitation and disturbed sleep were significant predictors of a diagnosis of mania. Problems of sleep and psychomotor agitation should alert clinicians that further assessment of bipolar symptomatology is warranted. Focusing on observable behaviours based on Diagnostic and Statistical Manual of Mental Disorder-IV criteria can be useful in formulating a diagnosis of bipolar disorder in persons with ID.
Journal of Intellectual and Developmental Disability, 2008
Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledg... more Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledge of how schizophrenia spectrum disorders (SSD) manifest themselves in individuals with intellectual disability (ID). In addition, little is known about the relationship between behaviour problems and psychopathology in this population. Utilising the Behavior Problems Inventory (BPI), three areas of problem behaviour (self-injurious, stereotyped, and aggressive/destructive) were assessed in 58 individuals with ID divided into three groups (with SSD, with a diagnosis of psychopathology other than SSD, and with ID only) and a total BPI score was calculated for each. The SSD group was unique when compared to the Control group (ID only) for frequency of stereotyped behaviours. Further, severity of stereotyped behaviours in the SSD group was unique compared to the Psychopathology and Control groups. The SSD group was unique compared to the other two groups, particularly for severity of stereotyped behaviours. Many specific behavioural differences were also related to either SSD or general psychopathology.
Journal of Developmental & Behavioral Pediatrics, 2013
The purpose of the study was to examine how access factors affect prescribing practices of psycho... more The purpose of the study was to examine how access factors affect prescribing practices of psychotropic medications among pediatricians. More specifically, the aim of the current study was to examine differences in the treatment of mental and behavioral health problems among children and adolescents across small nonmetropolitan, regional, metropolitan, and urban settings across the United States. A total of 516 pediatricians working in outpatient clinics located in 12 US states, 3 in each of the following regions: New England, the Plains, the Pacific Northwest, and the South completed surveys on their prescription practices for children and adolescents with mental and behavioral health needs. Findings indicate that pediatricians in small nonmetropolitan settings with populations of fewer than 20,000 prescribe antidepressants; antianxiety, antipanic, and antiobsessive medication; antipsychotics; and mood stabilizers significantly more frequently than their counterparts in urban, metropolitan, and regional settings. Implications of these findings for clinical practice and training are discussed.
To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavio... more To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22% of patient visits, was ≥90%. Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement.
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