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Volume 13 Number 1 News: Mental Health Starting in 2008, primary care physicians and nurses are required, under a court order that became effective Dec. 31, 2007, to give mental health screenings to children up to age 21 enrolled in Massachusetts' Medicaid program. A short, standardized behavioral health questionnaire must be offered at every physician's visit made for preventative care, according to a state Children's Behavioral Health Initiative fact sheet. Patients and primary care physicians are to discuss responses to determine if the child needs mental health services. The new requirements are mandated under a court ordered remedial plan in a lawsuit that accused the state of violating Medicaid provisions to provide early and periodic screening, diagnostic, and treatment services (EPSDT) with "reasonable promptness." The case, Rosie D. v. Romney ( D. Mass., No. 01-30199, 1/26/06), involved mental health screenings and services for children with serious emotional disturbances from eight low-income families (No. 19 HCDR, 1/30/06 a0b2f8h8h1 The remedial plan covers children eligible for EPSDT and who have serious emotional disturbances, a U.S. District Judge for the District of Massachusetts, Western Division, ruled in January 2006.
Screening Tools
MassHealth pays for annual checkups for ages 2 to 21 under so-called "well-child visits." Infants get more frequent, monthly checkups. The behavioral health screening "helps to identify behavioral health concerns early," MassHealth explained in the fact sheet.
MassHealth recommends that physicians and nurses use questionnaires developed under the Pediatric Symptom Checklist (PSC), the Parents' Evaluation of Developmental Status (PEDS), or some other questionnaire.
The PSC includes 35 questions that gauge how often a children exhibits certain behaviors, such as spending time alone, feeling sadness, fighting, or having trouble sleeping. The questionnaire is taken by parents and adolescents ages 11 and up, according to Bright Futures.
Michael Jellinek, professor of Psychiatry and of Pediatrics at Harvard Medical School, and J. Michael Murphy, a staff psychologist in the Child Psychiatry Service at the Massachusetts General Hospital, developed the PSC screening tool.
The PEDS questionnaire has 10 questions that parents answer about their children up to age eight, according to the PEDS Web site. The questions vary according to age, but include any behavioral or developmental concerns the parent may have. Frances Page Glascoe, a professor of Pediatrics at Vanderbilt University, developed the PEDS screening tool.
Other Plan Requirements
Under the court order, MassHealth was also required to improve its education and outreach for agency staff, health plan members, providers, and the public about EPSDT services by Dec. 31, 2007. The program also has to implement an improved and standardized behavioral-health assessment, and develop an information-technology system to track assessments, and treatment planning and delivery, by Nov. 30, 2008.
The state must also seek federal approval to offer new or improved community-based services to be implemented by June 30, 2009. Upon approval, MassHealth will provide new services, including to children with both a serious emotional disturbance and another condition, such as autism, the fact sheet said.
The Children's Behavioral Health Initiative fact sheet is available.
The court order is available.
The Pediatric Symptom Checklist is available.
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