Mental Health Screening (6 Through 20 years)
CHILD AND TEEN CHECKUPS (C&TC) FACT SHEET FOR PRIMARY CARE PROVIDERS
C&TC Requirements
Childhood Screening (www.dhs.state.mn.us)
webpage. These include the following:
Mental health surveillance is required at all
C&TC visits for all ages. This includes obtaining
the child and family’s mental health history and
the child’s history of exposure to trauma.
General Mental Health Screening Instruments
▪ Pediatric Symptom Checklist (PSC)
▪ Global Appraisal of Individual Needs (GAIN-SS)
General
Mental health screening using a standardized
instrument is strongly recommended for all
C&TC visits age 6 through 20 years.
For children 6 months through 5 years of age,
refer to the Social-Emotional Screening (0-5
Years) C&TC Fact Sheet
(www.health.state.mn.us).
Personnel
Mental health surveillance must be completed
by a licensed primary care clinician (MD, NP,
PA) or a Registered or Public Health Nurse (RN,
PHN) who has completed C&TC Comprehensive
training through MDH.
Qualifications for mental health screening are
instrument-specific; refer to the instrument’s
manual for more information.
Documentation
Surveillance must be documented in the C&TC
visit record. Document screening with the name
of the instrument, the score, and anticipatory
guidance with the parent/caregiver based on
the results. For positive results, document
referral and follow-up plan.
For documentation examples refer to the C&TC
Documentation Forms for Providers and Clinics
(www.dhs.state.mn.us).
Screening Procedure
Instruments
A list of recommended, standardized mental
health screening instruments, and a table with
more details on each instrument, are available
online in the C&TC Section of the DHS Early
Depression Screening Instruments
▪ Patient Health Questionnaire (PHQ-9)
▪ Kutcher Adolescent Depression Scale (KADS)
▪ Beck Depression Inventory II (BDI-II)
▪ Children’s Depression Inventory (CDI-2)
Referral
If screening results are positive or surveillance
presents concerns, it is critical that children are
referred for specialized services (Weitzman &
Wegner, 2015). The clinician must be prepared
to refer to available mental health services in
the community that can provide treatment
options for children and adolescents.
Referral resources may include mental health
services that are integrated in primary care,
available within health systems or in the
community, or school-linked mental health
service agencies that receive grant funding
through the Minnesota Department of Human
Services (DHS). Refer to the DHS website for
more information or a map of agencies across
the state (www.mn.gov/dhs).
Follow up
After making a referral, ensure the family
obtained services without encountering
barriers. With parental permission, follow up to
determine if services were effective (Weitzman
& Wegner, 2015). Provide more frequent C&TC
or other follow-up visits in clinic if needed.
Importance of Screening
In any given year, 13-20% of children in the
United States experience a mental health
condition (CDC, 2013). Identification of mental
health problems improves when primary care
MENTAL HEALTH SCREENING (6-20 YEARS) C&TC FACT SHEET
providers supplement interviews with a
standardized screening tool (SAMHSA, 2011).
Half of all lifetime cases of mental illness begin
by early adolescence (Weitzman & Wegner,
2015). Substantial evidence shows that early
mental health interventions help prevent
behavior problems and poor school
performance (Weitzman & Wegner, 2015).
Clinicians should also be aware that many
children and adolescents with mental health
concerns also have a co-existing substance
abuse disorder (SAMHSA, 2011). Refer to the
Substance Use Assessment C&TC Fact Sheet
(www.health.state.mn.us) for information
about assessing for substance abuse.
Professional Recommendations
American Academy of Pediatrics (AAP)
▪ Standardized screening is recommended at all
well-child checks beginning at 12 years of age
(American Academy of Pediatrics, 2014).
▪ Due to higher risk, the C&TC
recommendation for Medicaid-eligible
children is to provide social-emotional
screening beginning at 6 months through 5
years of age, and mental health screening at
every C&TC visit age 6 through 20 years.
U.S. Preventive Services Task Force (USPSTF)
▪ “Screening of adolescents (12-18 years of
age) for major depressive disorder when
systems are in place to ensure accurate
diagnosis, psychotherapy (cognitivebehavioral or interpersonal), and follow-up”
is a Grade B Recommendation” (US
Preventive Services Task Force, 2009).
Resources
Minnesota Department of Human Services
▪ Division of Children’s Mental Health
(www.dhs.state.mn.us)
▪ MHCP Provider Manual, Child and Teen
Checkups (www.dhs.state.mn.us)
Minnesota Department of Health
▪ Child and Teen Checkups
American Academy of Pediatrics
▪ Mental Health Initiatives (www.aap.org)
2
Other resources
▪ Preventing Mental, Emotional and Behavioral
Disorders among Young People: Progress and
Possibilities (www.nap.edu)
References
American Academy of Pediatrics. (2014, March).
2014 Recommendations for Pediatric Preventive
Health Care. Pediatrics, 133(3), 568-570.
CDC. (2013). Mental Health Surveillance among
Children-United States, 2005-2011. MMWR, 62(2), 135.
SAMHSA. (2011). Indentifying Mental Health and
Substance Use Problems of Children and
Adolescents: A Guide for Child-Serving
Organizations.
US Preventive Services Task Force. (2009). Screening
and Treatment for Major Depressive Disorder in
Children and Adolescents: US Preventive Services
Task Force Recommendation Statement. Pediatrics,
123(4), 1223-1228.
Weitzman, C., & Wegner, L. (2015). Promoting
Optimal Development: Screening for Behavioral and
Emotional Problems. Pediatrics, 135(2), 385-395.
For More Information
Minnesota Department of Health
Child and Teen Checkups Program
PO Box 64882,
St. Paul, MN (zip) 55164-0882
(phone) 651-201-3760
[email protected]
www.health.state.mn.us
Revised: 09/2016
To obtain this information in a different format, call:
651-201-3760.