TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > Clinical Information

43.2.3.6 Mental Health

Guidelines for Mental Health Screening

The mental health screen is part of every comprehensive medical check up. The age-specific interview tools and parent questionnaires are provided as an option for performing this screen. They are intended for use as part of a comprehensive pediatric assessment. If these interview tools are used outside the context of a comprehensive examination, the interviewer must remember to collect information usually gathered in a pediatric history: household members, prenatal/newborn history, client's health history, and family illnesses.

The purpose of the mental health screen is to identify problems in any of six domains: feelings, behavior, social interactions, thinking, physical problems, and other problems that may include substance abuse. The provider choosing alternative screening tools or techniques should be certain to screen in these domains. Screening may reveal several minor problems or one or more significant problems that warrant referral for, or provision of, evaluation and, if indicated, treatment. In determining whether behaviors are serious enough to warrant referral, the screener must weigh the extent and intensity of the problems and explore the client's resiliency and psychological and social resources. If the client has been or is under treatment for any mental health conditions, record that treatment in the client's medical record.

Referral options may include parenting education programs, ECI programs (birth to 3 years of age), mental health evaluation and counseling, substance abuse assessment and programs, acute psychiatric hospitalization, or child protective services. The screener's responsibility is to identify and establish a referral relationship with these resources in the community.

Screeners with special training and credentials allowing evaluation and treatment of childhood behavior problems, mental illness, or substance abuse may choose to provide these services rather than referring. Other screeners should refer to mental health specialists.

Confidentiality

The screener introduces the screen by explaining that the information provided will be held in strictest confidence unless the screener recognizes a situation that places the client or others in danger.

Clients older than 4 years of age should not be present when the screener questions the parent about possible abuse or neglect.

Beginning when the client is about 10 years of age, questions about peer and family social interaction and substance abuse are explored with the client and parent separately. All parts of the screen are administered to the adolescent and their parent/caregiver separately, when possible, recognizing that some families may object to confidential discussions with young people and cultural competency should be exercised.

If observations of the client, the parent, or parent-client interaction lead the screener to suspect possible abuse or neglect, the screener must make a report to Child Protective Services. The report is required even though the screener may refer a family for evaluation or treatment of abuse/neglect.

Behavior of Particular Concern

Behavior generally expressive of mental health problems include those listed below. If the screener finds any of the following significant behaviors, further screening is unnecessary because referral is indicated:

•Setting fires.

•Suicidal behavior or ideation.

•Self-destructive activities.

•Torturing animals.

•Hurting other people.

•Destroying property.

•Loss of touch with reality.

•Inappropriate sexual behavior.

•Substance abuse.

•Parental concern about their ability to maintain the client in the home.

Important: At the conclusion of a screening that is judged by the provider to be within regular limits, the screener should refer the client for a comprehensive mental health evaluation if the parent or the client (particularly an older client) is concerned that the client has mental health or behavior problems.

Interview Tools/Referral Forms

The interview tools found on pages C-20 through C-27 contain age-specific questions to guide the provider in conducting a mental health screen. Items of concern should be circled. Extensive notes may have to be made on a separate sheet. A copy of this form may be used as a referral form.

The parent questionnaire is similar to the interview tool. It is advisable in the first visit to explain and administer the interview face-to-face. At subsequent visits, the age-appropriate form may be given to a literate parent or adolescent with the instruction, "Circle any of these items that you feel are a problem or concern for your child/you and that you would like to discuss with your provider."