Children’s Mental Health, Substance Abuse Issues
Not Identified
States Underutilize Screening Tools, Says New Study
Washington, DC May 1, 2003—States are failing
to adopt the most effective policies under their Medicaid programs to
identify mental health or substance abuse problems in children, according
to a new national study published in the latest issue of Psychiatric
Services journal. The study, conducted by the Bazelon
Center for Mental Health Law, is the first to assess behavioral health
screening tool policies in the Medicaid programs of all 50 states.
“We found that nearly half of the states do not have Medicaid
policies in place to identify children with mental health and substance
abuse issues,” said Rafael Semansky, senior policy analyst at the
Bazelon Center and one of the study’s authors. “States need
to do more to promote the use of effective tools if their Medicaid systems
are going to identify and provide treatment for children who need services.”
Almost 21 percent of children and adolescents have a diagnosable behavioral
disorder. Under Medicaid’s Early Periodic Screening Detection and
Treatment (EPSDT) mandate, states are required to screen all children
on Medicaid for physical and behavioral health disorders—an estimated
20 million children each year. A 1999 Surgeon General’s report
recognized that identifying disorders is the critical first step in providing
mental health treatment.
Twenty-two states and the District of Columbia fail to include behavioral
health issues in their Medicaid-recommended screening instruments for
children, according to the study. Primary care providers, who are generally
responsible for such screenings, generally have little training in mental
health and substance abuse. The study found that in many states primary
care providers receive no guidance from Medicaid agencies on screening
tools that would help them accurately identify behavioral health problems.
Previous studies have found that pediatricians who rely only on professional
judgment miss more than 40 percent of children with a diagnosable disorder,
and that the use of standardized, specialized tools considerably increases
identification rates.
“States can’t provide treatment for children’s mental
disorders and substance abuse if they don’t know problems exist,” said
Semansky. “States need to recommend specific questions for primary
care providers to ask during screening visits.”
The study also found that more states address mental health than substance
abuse issues in their EPSDT screening tools. Twenty-seven states reference
mental health in their screening policies, while only 13 reference substance
abuse.
The article summarizing the study, Behavioral Health Screening Policies
in Medicaid Programs: A National Perspective, was written by Semansky,
Bazelon Center policy director Chris Koyanagi and Rita Vandivort-Warren,
senior public health analyst in the Organization and Financing Branch
of the Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services.
Media can obtain the study online at http://psychservices.psychiatryonline.org/.
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The Bazelon Center for Mental Health Law is the nation’s leading
advocate for the rights of children and adults with mental disabilities.
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