Implementing mental health screening in children state-wide: Challenges and lessons learned

Screening in pediatrics for behavioral health issues with standardized tools has been recommended by multiple governmental reports. To date, statewide use of standardized screening tools has been recommended but not at the level of the Massachusetts' regulatory mandate.

In Massachusetts, the Executive Office of Health and Human Services and MassHealth, in order to implement requirements of a court order resulting from a lawsuit known as Rosie D, et al v. Patrick, established a mandate for primary care providers (PCPs) to offer a behavioral health screening of children using a standardized screening tool. The case, which focused on the rights of children with severe mental health issues, was interpreted in a broad decision that now requires all PCPs caring for MassHealth enrolled children <21 years whose benefit package includes primary care service, to choose a clinically appropriate screening tool from a menu approved by the Commonwealth. Tools are to be used during periodic or interperiodic preventive pediatric visits required under the EPSDT periodicity schedule. MassHealth provides reimbursement for screening and will be developing processes to provide utilization data to PCPs.

MassHealth provided training for physicians, web-site support and identified providers with screening expertise to assist practices during the implementation phase. Implementation issues have ranged from clinical time available, to concerns about the tools, to electronic medical record adaptation. This presentation will provide lessons learned in implementing the universal use of standardized behavioral health screening tools in primary care practices and provide important information for other states considering mental health screening recommendations.