Behavioral Health-Works

TM
(BH-Works)

A multi-component mental health screening

program for Primary Care, Emergency
Departments, Hospitals, Schools, and Mental
Health Centers
 The Behavioral Health Works (BH-WorksTM) Program

BH-Works is a proven web-based system for integrating behavioral health screening, triage, and
prevention services into medical, school, and mental health services settings. The BH-Works
Program consists of provider education, web-based screening, and assisting in building a strong
behavioral health care environment. The centerpiece of this program is the Behavioral Health
Screening tool (BHS). This web-based screen targets suicide and a number of associated
behavioral health problem areas. Typically, a patient or student will complete this screen before
an in-person meeting with a medical provider. The system will score the report instantaneously
and generate a report that the provider reviews before meeting with the patient or student. The
BHS can be administered when a patient/student is identified as at-risk or as part of regular
universal screening for all patient/students. The BHS has strong psychometric support and has
been validated for youth and adults, ages 12 and above. Developed through collaboration
between Baltimore-based Medical Decision Logic, Inc. (mdlogix), a leading provider of health
informatics solutions and services, and clinical investigators at the University of Pennsylvania
and the Childrens Hospital of Philadelphia (CHOP), the BH-Works Program provides:

Web-based Screening and Results:

o Covers 13 Domains in 7 minutes
o Instantly generates a report for review by provider
o Identifies Critical Issues: Suicide, Violence, Gun Access
o Automatically Scores: Depression, Anxiety, Suicide, Traumatic Distress,
Substance Abuse, Eating Disorders
o Identifies Risk Behaviors: Substance Abuse, Safety Risks, Bullying
o Identifies Patient Strengths: Grades, Exercise
o Data can be downloaded into an EMR and aggregated for monitoring quality
assurance.
Medical Provider Education, Training, & Mental Health Collaboration
o Clinic Preparation and Readiness
o Web-based educational videos, materials, and workshops on mental health
assessment & triage
o Office procedures for managing suicide and other crisis
o Strengthening relationships with mental health referral sources
Applicability to Multiple Healthcare Settings
o Primary Care
o Emergency Departments and Hospital Units
o Mental Health Clinics & Crisis Services
o Colleges and Universities
o Schools
A mechanism to address needs identified and/or recommended by:
o The Joint Commission
o American Academy of Pediatrics
o American Psychiatric Association
o U.S. Preventive Services Task Force

The BH-Works Program has been in use at the Childrens Hospital of Philadelphia Emergency
Department since 2007, and is currently in use at over 40 primary care offices, crisis centers, and
student health centers across the state of Pennsylvania. A proven solution for screening,

Copyright 2008-2014 Medical Decision Logic, Inc. All Rights Reserved

prevention, and treatment of mental health issues for numerous healthcare settings, BH-Works
can be rapidly deployed into primary care, emergency departments, colleges/universities, and
schools across the United States (as well as internationally).

By utilizing the BH-Works Program, the U.S. can improve primary and mental health care while
reducing the significant costs associated with care given as a result of untreated mental health
issues.

Streamlined Workflow:

Screen all Staff/Nurse gives

Patients/Students orientation.

Regularly OR Logon is created

As Identified
1 2

Patient completes
3 BHS in a Private
Setting
BH-Works
(< 10 min)
6
Report and providers
review may be 4
billable Staff/Nurse prints and
adds the report to
5 patient chart or EMR
Provider reviews
report with patient
and makes referrals if EMR
needed

Copyright 2008-2014 Medical Decision Logic, Inc. All Rights Reserved

Real-Time Reporting:

BH-Works provides real-time reports at an individual patient level as well as across all patients.
Upon the completion of each patient screening, the system automatically generates the Screen
Results report. These results are then combined with the patients other screening results in the
Patient Trends Reports.

Screen Results Patient Trends Report

In addition, all individual results are rolled up across all patients to provide population-wide data
provided in both the Facility Screen Report as well as the data export.

Facility Screen Report

Copyright 2008-2014 Medical Decision Logic, Inc. All Rights Reserved

Data Export

Psychometric Support for the BHS Scales:

Analyses indicate that the Behavioral Health Screen is a reliable and valid tool for the
measurement of adolescent and young adult behavioral health. The BHS has strong psychometric
properties and has been deemed feasible by patients and providers. Psychometric analyses were
conducted with data collected from 400 adolescents aged 12 to 21 years (M = 15.87, SD = 2.12).
The majority of adolescents were African American (81.06%); remaining adolescents were White
(5.28%), more than one race (10.87%), or another race (2.79%). Approximately 9% of
adolescents were Hispanic.

Internal Consistency. The subscales (depression, suicide, substance use, anxiety, PTSD, and
eating disorder) demonstrated good unidimensionality and internal consistency (s range from
.75 to .88).

Convergent and Divergent Validity. The BHS scales were compared against several other well-
validated gold standard scales in the field. These scales included the Beck Depression Inventory
II, Scale for Suicide Ideation, Trauma Symptom Checklist (PTSD and anxiety), and the General
Inventory of Individual Needs (Substance use; GAIN). The BHS scales showed good
discrimination between each other and significant correlations with the corresponding
standardized measures (r=.41 to .65, p<.05).

Sensitivity and Specificity. Analyses were used to establish cutoff scores on the BHS scales that
maximized both true positive and true negative classifications of clinically significant behavioral
health problems, as indicated by scores on the validation measures. The operating curve
characteristics of the BHS subscales are generally satisfactory. For each subscale, the probability
of correctly distinguishing adolescents who have clinically significant behavioral health
symptoms from those who do not exceeded 75%. The greatest risk of misclassification is falsely
identifying adolescents with subclinical anxiety symptoms as anxious (specificity = 67%).

Youth Suicide Prevention in Primary Care (YSP-PC): The Pennsylvania Model

Five years ago, the Office of Mental Health and Substance Abuse Services (OMHSAS)
obtained a Garrett Lee Smith (GLS) SAMHSA grant to carry out a systems change
project focused on suicide prevention in primary care for youth (ages 14-24). The project
is now located in 25 sites in 14 counties. The project has four aims.
I. Develop a broad stakeholders taskforce to ensure that the program fits within
the ecology of the targeted medical practices and counties.

Copyright 2008-2014 Medical Decision Logic, Inc. All Rights Reserved

 II. Implement training to medical staff about suicide risk assessment and related
mental health concerns.
III. Implemented a web-based screening tool that is completed and scored in the
medical office during a patients visit.
IV. Enhance partnerships between medical and mental health providers.
Although initially targeting primary care, the program has expanded to include several
other medical contexts. Our sites consist of various healthcare settings including:
o Primary Care
o Emergency Departments and Hospital Units
o Mental Health Clinics
o Colleges and Universities
o Schools (high, middle, & elementary)

Mental Health Outcomes & Screening Results:

Suicide Rates. Suicide. To date, we have screened over 10,000 patients in emergency
departments and 5050 adolescents in primary care. In the primary care sample, 210 (4%)
identified as having current suicidal ideation. An additional 652 youth endorsed having lifetime
history of suicidal ideation, which our data indicates is a flag for youth at risk. Of concerns is that
the screen also indicates that nearly 20% of youth with current suicide ideation also had access to
a gun.

Co-morbid Mental Health. In addition to identifying those who endorsed suicidal ideation and/or
behaviors, the BHS detects patients with other psychosocial problems that place them at risk for
mental health distress, let alone suicide risk. .

Number Suicide Depression Eating Substance

Anxiety Trauma
Screened (current) ** Disorder Abuse

210 1,127 1,482 1,302 150 148

5,050
(4%) (22%) (29%) (26%) (3%) (3%)
** Includes moderate and severe depression

Violence Prevention. Given the violent events occurring in the nation in the last few months and
years, there is a growing interest in how mental health providers can assist in early identification
of youth with the potential to commit mass violence (e.g. school or public shootings). Although
there are no validated screens for predicting youth violence, the broad assessment reach of the
BHS can help identity youth at risk. BHS now has a new scale on being bullied, which is a risk
factor for violent youth. The BHS also includes an item that asks if the youth has access to a gun
in the home. A positive response to this question provides an opportunity for a provider to do
gun safety education for the family. In addition, if the patient screens positive for behavioral
health problems, in particular having suicidal thoughts, and endorses having access to a gun, then
this is a high risk situation that may need immediate attention. Below is the data we currently
have on youth who positively endorsed several behavioral health risk factors and whether or not
they had access to a gun. Of note, 16.7% of youth screened who were at risk for suicide and
10.3% who were at risk for depression had access to a gun.

Copyright 2008-2014 Medical Decision Logic, Inc. All Rights Reserved

Patient and Provider Satisfaction. 85% of patients screened reported that they were at least
neutral or comfortable answering the BHS questions, at least 75% were neutral or comfortable
talking about answers with medical providers, 31.8% and 43.3% of screened patients say medical
provider never asks about feelings or experiences, respectively.

For Demo or Further Information Contact:

Matt Briner Guy Diamond

mdlogix Drexel University & CHOP
Director of Clinical Products Project Director
443.278.8830 215.571.3420
mbriner@mdlogix.com gd342@drexel.edu

Copyright 2008-2014 Medical Decision Logic, Inc. All Rights Reserved

 Behavioral Health Screening
Introduction
The need for behavioral health screening is a national priority, but few validated screening tools are
available for this setting. Our validated product suite, BH-Works, is composed of mdlogix health science-
based information technology combined with a validated Behavioral Health Screening tool. BH-Works is a
web enabled application currently deployed in Emergency Departments (ED), Crisis Centers, Primary
Care Offices, Mental Health Clinics, and Schools/Universities.

Challenge
Limitations of Existing Screening Tools:
Usually address only a single domain (e.g., depression)
Only covers current and past two weeks symptoms, even though many visits are
yearly (well-visits)
Lacking psychometric validation
Paper and pencil administration or Local PC software
No electronic or centralized data

Solution
BH-Works is a validated screening application designed specifically for multiple healthcare
settings. It goes beyond most depression screening tools by offering a full psychosocial
assessment on a self-report, internet-based system that scores the data for busy clinicians.
Comprehensive screen includes up to 13 domains (e.g., depression, anxiety, trauma)
Strong reliability and validity data on the scales and items
Reports automatically generated with scaled scores and critical items flagged
Flexible web tool and platform allows for site-specific additional assessment items

Benefits
Brief administration time (5-10 minutes)
Streamlined access, administration and enhanced workflow
Ability to interface with Electronic Medical Records (EMR)
Health Insurance Portability and Accountability Act (HIPAA) compliant
Ability to generate aggregate reports at the patient or practice level
Proven in Emergency Department, Primary Care Practice settings

Representative Deployments Client Results

The Children's Hospital of Philadelphia ED Practitioners who
State of Pennsylvania Department of Health have implemented
Primary Care Offices the BH-Works at the
Mental Health Clinics Childrens Hospital of
Crisis Centers Philadelphia view the
Schools & Universities tool as integral to
their mission of
providing quality
www.bh-works.com health care services
 Behavioral Health Screen (BHS)
Comprehensive Screen
Behavioral Health Screen (BHS) The BHS was developed by the Center for Family
Intervention Science at Childrens Hospital of Philadelphia to address the need for
comprehensive behavioral health screening in primary care.
The BHS is designed for an adolescent and adult patient populations and consists of
psychiatric symptom scales and risk behaviors that cover all the psychosocial areas suggested
by best practice guidelines.
The items were reviewed by a team of 20 national experts and by several physician focus
groups.
The BHS contains 61 core items with an additional 48 embedded items that are presented
when certain items are positively endorsed. Depending on the number of problems endorsed,
it takes about 5 to 10 minutes to complete the BHS

Key Domains
School Depression
Family Anxiety
Substance Abuse Suicide and Self Harm
Sexuality Trauma
Safety Nutrition and Eating
Demographics Psychosis
Medical Bullying

Key Validated Scoring Scales

Scale Score The system

generated report
Depression 0-4 ; Mean of 5 items provides scores for
the key domain
Anxiety 0-4 ; Mean of 4 items scales. These
scores are based
Suicide - Current 0-4 ; Mean of 3 items on the clinically
significant
Traumatic Distress 0-4 ; Mean of 3 items categories based
on these well-
Eating Disorder 0-4 ; Mean of 4 items
validated
Substance Abuse 0-4 ; Mean of 4 items measures.
 Immediate Screening Results
Automatic Scoring and Report Generation
When a patient completes the BHS, the self reported responses will be scored and
the system will generate a report.
Only staff can view and/or print the report
The report will include a results summary sheet followed by a listing of all items and
the answers selected.

Example Work Flow
Clinical Staff Benefits
Patient/Parent Enters
Visits Registration
Information
(BHS is offered)
Staff Conducts BHS
Orientation if BHS is
elected. Patient Benefits
Logon is Created.
Patient Completes the
Screen in the Exam
Room
(Approx. 7-9 Minutes)
Doctor Benefits
Clinical Staff Prints and
Adds the Report to
Patient Chart
Doctor Reviews Report
with Patient and Makes
Referrals
Streamlined Workflow
Easy to Administer
Integrates Easily into
Registration Process
Minimal Input
Instant Scoring
Minimal disruption to
workflow
Does not single out patients
Earlier Diagnosis and
Treatment
More Comprehensive
Healthcare Services
Self Reported in a Private
Setting (i.e., Exam Room)
Does not single out patients
(Offered to Everyone
During Sign-in)
Summary Results
Validated Tool with Scores
Aids in overall diagnosis
Allows for securing social
history for billing
Report and Doctors
Review May be Billable
 Web Technology

Flexible Web Based Application

The Web-Based application allows for greater flexibility in deployment of the tool
in different settings:
Patients can access the screening tool from any computer with internet
access or any web-enabled device (Netbook, iPad, PDA etc.).
Provides instant scoring of results to staff.
Can interface with electronic medical record systems.
 Summary & Next Steps
Solution
BH-Works is a validated screening application designed specifically for multiple healthcare
settings. It goes beyond most depression screening tools by offering a full psychosocial
assessment on a self-report, internet-based system that scores the data for busy clinicians.
Comprehensive screen includes up to 13 domains (e.g., depression, anxiety, trauma)
Strong reliability and validity data on the scales and items
Reports automatically generated with scaled scores and critical items flagged
Flexible web tool and platform allows for site-specific additional assessment items

Benefits

Clinical Staff Benefits Patient Benefits

Easy to Administer Earlier Diagnosis and Treatment
Integrates Easily into Registration More Comprehensive Healthcare
Process Services
Minimal Input Self Reported in a Private Setting
Instant Scoring (i.e., Exam Room)
Minimal disruption to workflow Does not single out patients (Offered
Does not single out patients to Everyone During Sign-in)

Doctors Benefit Hospital Administrators

Summary Results Best Practices supports BHS
Validated Tool with Scores Better overall services
Aids in overall diagnosis Facilitates provision of additional value
Allows for securing social history for adding services (Psychiatric Services)
billing

For Demo or Information Contact Client Results

Matt Briner The practitioners
Director of Clinical Products at the Childrens
Hospital of
(443) 465-0436 Philadelphia view
www.bh-works.com the tool as integral
to their mission of
providing quality
health care
services
The BH-WorksTM
Program

BH-Works is a proven, 100%

web-based system for integrating
behavioral health screening, triage,
and prevention services into medi-
cal, school, and mental health ser-
vices settings. The BH-Works Pro-
gram consists of provider educa-
tion, web-based screening, report-
ing, and assistance in building a
strong behavioral health care envi-
ronment.
For more information, scan or visit:
Key Benefits:
100% Web-based

Brief Administration time (under

10 minutes)

Multi-level reports instantly www.bh-works.com

scored & immediately available

Designed for: Primary Care,

Emergency Departments, Mental
Health Clinics, Universities,
Powered by:
Schools, and many others...

The Behavioral
Health-Works TM
Medical Decision Logic, Inc. Screening Program
1216 East Baltimore Street
Baltimore, MD 21202
Phone: 410-828-8948 www.bh-works.com
Fax: 410-276-2098
E-mail: info@mdlogix.com

Web-Based Screening
Behavioral Health Screen-
ing can improve early
identification, risk manage-
ment, triage, tracking, and
outcomes monitoring.
BH-Works provides a comprehensive (61
core + 46 additional items) and highly effi-
cient behavioral health screen covering 13
domains in under 10 minutes (including):
Suicide & Depression
Trauma & Psychosis
Substance Abuse
Anxiety & Bullying
Personal & Family Factors
Eating Disorders
Medical & School
The BH-Works Program has strong psycho-
metric support and has been developed for
youth and adults ages 12 and above.
Immediate Screening Results:
Staff Education & Readiness
Staff education and readiness is essential for
any task. BH-Works helps prepare your staff
and facility by providing online training videos
and materials in the following areas:
Upon the completion of a screen, BH-Works im-
mediately scores and summarizes the screening Facility/Clinic Readiness
results, identifying: Screening Workflow
Critical Items: Suicide, Psychosis, Abuse Results Interpretation
Risk Behaviors: Bullying, Violence, Gun Access Building relationships with behavioral
health resources for referrals
Patient Strengths: Grades & Employment
Automatically Scores Domains: Depression,
Suicide, Anxiety, Suicide, Traumatic Distress,
Substance Abuse, & Eating Disorders
Quality
Improvement
& Outcomes:
Track your patients progress over time with the
Patient Trends Report (above). With the BH-
Works program, you can also track your entire
patient population and facilitys screening activity
easily with multi-level reporting features including
facility screening activity reports and data export.
www.bh-works.com