Rosie D.
Reforming the Mental Health System in Massachusetts

Step 2:  Mental Health Evaluation 


Children who are screened or identified as having a potential mental health condition must be referred for a mental health evaluation.  Following the initial evaluation, the clinician can make a diagnosis, and begin developing a treatment plan.  Some children who are determined to have a serious emotional disturbance (SED) will be referred for intensive care coordination and home-based services; others, who do not have SED, still may be eligible for home-based services.


Who is Evaluated:   Every child who is screened and found to have a potential mental health condition must be either treated by the primary care professional or referred to a mental health professional for an evaluation. Children who have not been screened, but who are identified as having a mental health condition or as needing mental health service, must be referred immediately for a mental health evaluation.  An evaluation is required for high-risk children who are at risk of out-of-home placement and children who are discharged from hospitals, intensive residential programs or other Department of Mental Health facilities.  


Who Conducts the Evaluations:  Evaluations must be done by a certified mental health professional, who may be located at a mental health clinic or program, a health care centers or school, or in private practice. 


The Evaluation:  Mental health professionals will evaluate children using a standardized instrument called the Child and Adolescent’s Needs and Strengths (CANS) questionnaire.   The questionnaire seeks information about the child’s social functioning skills and behaviors at home, at school and in the community.  The CANS asks questions about the child’s medical and physical needs as well as the child’s strengths – his or her family, disposition and outlook, talents, interests and capabilities.  The CANS is designed to indicate a child’s current level of need for services.  The Commonwealth has  trained and certified almost 7,000 clinicians to conduct the CANS. 


The evaluation will also include a determination of whether the child has a serious emotional disturbance (SED).  SED children have a mental health diagnosis and a functional impairment that substantially interferes or limits a child’s role in the family, school, social relationships, or community, or that substantially interferes with or limits a child or adolescent from achieving or maintaining developmentally appropriate social, behavioral, cognitive, communicative, or adaptive skills.


The Findings:  A child who is diagnosed with SED is eligible for intensive care coordination and a comprehensive home-based assessment for home-based services.  Even if the child is determined not to have SED. s/he still may be eligible for all other home-based services.  If the CANS assessment indicates that the child’s mental health needs can be addressed adequately through clinic-based or office-based outpatient services, then the child must be provided outpatient services with ongoing behavior monitoring from a mental health agency/ provider/clinician.


If during the assessment process, it appears that a child is in crisis or in urgent need of specific home-based services, such services will be deemed medically necessary and will be provided promptly, unless the parent or guardian objects.


For more detailed information on the evaluation process, read the Feature on CANS.


Click here for Step 3, Intensive Care Coordination




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