Rosie D.
Reforming the Mental Health System in Massachusetts

Step 1:  Screen and Identify Needs

Screening is the first step along the Pathway to Home-Based Services.  In response to the Court ordered Remedial Plan, the Commonwealth has initiated this service and now requires behavioral health screenings for all Medicaid-eligible children. 

As of January 1, 2008, primary care physicians or nurses must screen children for behavioral health needs during routine well-child office visits or at a parent’s request.  The purpose of the screen is to identify potential mental health conditions and, if necessary, treat them before they develop into hard-to-manage crises.


Legal requirements:  Behavioral health screening is mandated under the federal Medicaid Act’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) provision.  MassHealth, which administers Medicaid in Massachusetts, is required to cover EPSDT screenings for Medicaid-eligible children.  

Who Is Screened:  As part of a periodic and any other interperiodic EPSDT behavioral health screening, all Medicaid-eligible children routinely examined by a pediatrician, family practitioner, or other health care professional will be formally screened for behavioral health conditions.  Children generally visit a primary care doctor or nurse at least annually; very young children see clinicians more frequently.  Children in the care or custody of state agencies can be referred at any time to a medical provider or healthcare professional for a behavioral health screen.   The agencies are responsible for promptly referring the child to an appropriate medical provider and making reasonable efforts, including tracking, outreach, and assistance, to ensure that the screen is completed in a timely manner. 

Screening Instruments:  Clinicians can use any one of six standardized screening instruments or questionnaires to identify a possible mental health condition and the need for further evaluation or treatment.  The questionnaires include the Pediatric Symptom Checklist (PSC), the M-CHAT, the CRAFFT and the Parents’ Evaluation of Development Status (PEDS).  The instruments seek varied information about a child’s behavior, and address such topics as social skills, mood, energy level, school performance and sleeping habits.   Different instruments are targeted for different age groups.

The Purpose of Screening:   Through a behavioral health screening, health care professionals can identify the need for further corrective treatment and intervene earlier to address potential emotional, behavioral or psychiatric concerns.   Primary care doctors, nurses or other health care professionals must identify the children who have a potential mental health condition or may need mental health services.  These clinicians can treat the child or refer him/her to a specialist who will conduct a mental health evaluation.  Children with identified mental health conditions who already are known to state or local agencies do not need a formal screening to move along the Pathway to Home-Based Services.


Other Methods to Identify a Mental Health Condition:  As part of the regular intake and evaluation process, state agencies, schools, and child care centers are often required to assess children, and identify children who have a behavioral health condition or concern. 

For a more detailed information on screening, please read the Feature on Screening.

Click here for Step 2, Mental Health Evaluation

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