Welcome to the training on Adolescent Substance Use provided by Texas Health and Human Services (HHS) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and others with the tools to integrate substance use screening and intervention into practice, employ current evidence-based models to manage adolescent patients who use substances or are in recovery, and to refer patients when necessary.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Differentiate between the updated diagnosis of substance use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the previous definition found in the DSM-IV.
- Detect behavioral, physical, and emotional red flags for adolescent substance use disorders.
- Interpret factors that can increase the risk for substance use disorders and addiction.
- Summarize evidence-based theoretical models for managing and treating substance use disorders.
- Employ motivational interviewing techniques to discuss substance use with adolescents.
- Assess an adolescent on the spectrum of substance use disorders.
- Integrate an adolescent and his or her family in treatment.
Please note this module expires on 8/28/2018.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This course has been designated by The Texas Department of State Health Services, Continuing Education Service for 1.5 credit(s) of education in medical ethics and/or professional responsibility.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is an accredited provider (P0180) of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) of Continuing Social Work Education.
This course has been designated by The Texas Department of State Health Services for 1.5 contact hours of education in professional ethics and social work values.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.5 total entry-level Category I contact education contact hours.
Licensed Professional Counselors
The Texas Department of State Health Services (DSHS), Continuing Education Service is an approved provider (#12600) by the Texas State Board of Examiners of Professional Counselors to offer continuing education contact hours to Licensed Professional Counselors. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) for Licensed Professional Counselors. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) in professional ethics for Licensed Professional Counselors.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.5 contact hour/s of continuing education for Certified Community Health Workers.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service certifies that this attendee participated in the educational activity listed above. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. Planning Committee/ Author Name of Commercial interest Nature of the Relationship LeAnn Kridelbaugh Salary Employment (Director of Medical Home Initiatives).
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
- Addictions and Recovery website.
- Ali, S., Mouton, C. P., Jabeen, S., Ofoemezie, E. K., Bailey, R. K., Shadid, M., & Zeng, Q. (2011). Early Detection of Illicit Drug Use in Teenagers. Innovations in Clinical Neuroscience, 8(12): 24–28.
- Alliance for Consumer Education. (2012). Inhalant Abuse Prevention.
- American Academy of Pediatrics, news release. (2015). American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use.
- American Academy of Pediatrics. (2011, reaffirmed, 2014). Policy Statement: Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics, 128(5): e1330-e1340.
- American Academy of Pediatrics. (2010). Policy Statement, Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics, 125(5): 1078 -1087.
- American Academy of Pediatrics. (2010). Performing Preventive Services: A Bright Futures Handbook, Adolescent Alcohol and Substance Use and Abuse.
- American Dental Association. (n.d.). Oral Health Topics: Meth Mouth.
- American Psychiatric Association. (2013). Substance-Related and Addiction Disorders.
- American Society of Addiction Medicine. (2011). Definition of addiction.
- Boston Children’s Hospital. (2014). Screening to Brief Intervention (S2BI).
- Boston Children’s Hospital, Center for Adolescent Substance Abuse Research. (2009). CRAFFT screening tool.
- Centers for Disease Control and Prevention. (2015). Tobacco Use Among Middle and High School Students — United States, 2011–2014. Morbidity and Mortality Weekly Report, 64(14): 381-385.
- Centers for Disease Control and Prevention, news release. (2015). Expanding Naloxone use could reduce drug overdose deaths and save lives.
- Centers for Disease Control and Prevention. (2012). 2012 Surgeon General's Report—Preventing Tobacco Use Among Youth and Young Adults.
- Centers for Disease Control and Prevention. (2002). Policy Issues and Challenges in Substance Abuse Treatment.
- Chassin, L. (2008). Juvenile Justice and Substance Use. Future Child, 8(2): 165-83.
- Clinical Tools, Inc. (2015). DMS-5 opioid disorder checklist.
- Crocker. K. (2015). Adolescent Substance Abuse: How to Interview and Assess in the Primary Care Setting. Journal for Nurse Practitioners, 11(4): 471-472.
- D’Onofrio, G., O’Connor, P. G., Pantalon, M. V., Chawarski, M. C., Busch, S. H., Owens, P. H., … Fiellin, D. A. (2015). Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial. The Journal of the American Medical Association (JAMA), 313(16): 1636-1644.
- Ernst, D., Miller, W. R., & Rollnick, S. (2007). Treating substance abuse in primary care: a demonstration project. International Journal of Integrated Care, 7, e36.
- Harm Reduction Coalition.
- Holleran Steiker, L. (2015). Youth and Substances: Prevention, Intervention, and Recovery. Lyceum Books Inc.
- Jensen, R. P., Luo, W., Pankow, J. I., Strongin, R. M., & Peyton, D. H. (2015). Hidden Formaldehyde in E-Cigarette Aerosols. The New England Journal of Medicine, 372: 392-394.
- Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. The International Journal of Drug Policy, 21(3): 202–207.
- Krentzman, A. R., Robinson, E. A. R., Moore, B. C., Kelly, J. T., Laudet, A. B, White. W. L., … Strobbe, S. (2010). How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives. Alcoholism Treatment Quarterly, 29(1): 75-84.
- McCauley, K. T. (2013). Neurobiology of Addiction: Is Addiction Really a ‘Disease’? American Association for Marriage and Family Therapy Institutes for Advanced Clinical Training—Substance Use Disorders and Adolescents.
- Mersy, D. J. (2003). Recognition of Alcohol and Substance Abuse. American Family Physician, 67(7): 1529-1532.
- Moberg, D. P., & Finch, A. J. (2008). Recovery High Schools: A Descriptive Study of School Programs and Students. Journal of Groups in Addiction & Recovery, 2: 128–161.
- Naimi, T. S., & Mosher, J. F. (2015). Powdered Alcohol Products: New Challenge in an Era of Needed Regulation. The Journal of the American Medical Association JAMA. Published online June 15, 2015. doi:10.1001/jama.2015.6450.
- National Center on Addiction and Substance Abuse, Columbia University. (2000). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse.
- National Council on Alcoholism and Drug Dependence. (n.d.). Family Disease.
- National Institute on Drug Abuse, Research Report Series. (2010). Comorbidity: Addiction and Other Mental Illnesses.
- National Institute on Drug Abuse. (2015). Drug Facts: Marijuana.
- National Institute on Drug Abuse. (2015). Drug Facts: Is Marijuana Medicine?
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
- National Institute on Drug Abuse. (2014). Hallucinogens - LSD, Peyote, Psilocybin, and PCP.
- National Institute on Drug Abuse. (2007, revised 2014). Drugs, Brains, and Behavior: The Science of Addiction.
- National Institute on Drug Abuse. (2013). Drug Facts: Salvia.
- National Institute on Drug Abuse. (2012). Drug Facts: K2/Spice ("Synthetic Marijuana").
- National Institute on Drug Abuse. (2012). Drug Facts: Inhalants.
- National Institute on Drug Abuse. (2012). Synthetic Cathinones (“Bath Salts”).
- National Institute on Drug Abuse, NIDA for Teens. (2012). Help Prevent Prescription Drug Abuse: Ask Mom and Dad to Clean Out the Medicine Cabinet.
- National Institute on Drug Abuse, news release. (2008). Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults.
- National Institute on Drug Abuse. (2008). Addiction Science: From Molecules to Managed Care.
- National Institute on Drug Abuse. (2003). Preventing Drug Use Among Children and Adolescents: A Research-based Guide for Parents, Educators and Community Leaders.
- Padwa, H., Urada, D., Antonini, V. P., Ober, A., Crevecoevr-MacPhail, D. A., & Rawson, R. A. (2012). Integrating Substance Use Disorder Services with Primary Care: The Experience in California. Journal of Psychoactive Drugs, 44(4): 299–306.
- Pro-Change Behavior Systems, Inc. (2014). The Transtheoretical Model.
- Schulte, M. T., & Hser, Y-I. (2014). Substance Use and Associated Health Conditions throughout the Lifespan. Public Health Reviews, 35(2).
- Search Institute. (2015). 40 Developmental Assets for Adolescents.
- Sterling, S., Kline-Simon, A. H., Wibbelsman, C., Wong, A., & Weisner, C. (2011). Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implication for practice and policy. Addiction Science & Clinical Practice.
- Stewart, K. and Texas Department of State Health Services. (n.d.). Recovery-Oriented Systems of Care: Substance Use and Mental Health.
- Sutherland, I., & Shepherd, J. P. (2001). Social dimensions of adolescent substance use. Addiction, 96(3): 445-58.
- Tatarsky, A., & Kellogg, S. (2010). Integrative harm reduction psychotherapy: a case of substance use, multiple trauma, and suicidality. Journal of Clinical Psychology: In Session, 66(2): 123—135.
- Texas Department of State Health Services, Texas Health Steps. (2015). Anticipatory Guidance-A Guide for Providers.
- Texas Department of State Health Services, Mental Health and Substance Abuse Division. Texas Recovery Initiative.
- Texas Department of State Health Services. (2015). Recovery-Oriented Systems of Care (ROSC) web page.
- Texas Legislature, 84th session. Senate Bill 1462.
- University of Michigan. (2014). Monitoring the Future: National Survey Results on Drug Use, 1975-2014. Overview: Key Findings on Adolescent Drug Use.
- U.S. Department of Health and Human Services, National Institutes of Health. (2011). Why Nicotine is a Gateway Drug.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2015). HHS launches multi-pronged effort to combat opioid abuse.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2015). Substance Use Disorders.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2014). Prevention Efforts for Specific Populations.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2014). Recovery and Recovery Support.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2011). Recovery Defined – A Unified Working Definition and Set of Principles.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2004). Treatment Improvement Protocol (TIP) Series No. 39: Substance Abuse Treatment and Family Therapy.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.
- U.S. Department of Health and Human Services, Office of Adolescent Health. (2015). Texas Adolescent Substance Abuse Facts.
- National Institute on Drug Abuse. Commonly Abused Drugs Charts web page.
- Texas Certification Board of Addiction Professionals.
- Texas Department of State Health Services. (2014). Licensed Chemical Dependency Counselor web page.
- U.S. Department of Health and Human Services, Indian Health Service. (2006). Child and Adolescent Biopsychosocial Assessment.
- University of Nevada School of Medicine. (n.d.). Bio-Psycho-Social-Spiritual Model.
- Addictions and Recovery.org, public education website maintained by Steven Melemis, MD, PhD of Toronto, Canada, who specializes in addictions and mood disorders. The website provides information for individuals, families, and health professionals, including Help for the Family web page.
- Addiction Education Society. Information and educational resources about addiction, including blogs, parent support resources, and lesson plans for educators.
- National Alliance on Mental Illness offers families a fact sheet about co-occurring mental disorders: Dual Diagnosis: Adolescents with Co-Occurring Brain Disorders and Substance Abuse Disorders.
- National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia). Teen Substance Useweb page.
- National Child Traumatic Stress Network. Educational materials for youths, parents, and caregivers about the links between stress and substance use.
- National Institute on Drug Abuse. NIDA for Teens, a website for middle and high school students, parents, and teachers with information about drugs and neuroscience. “Marijuana: Facts for Teens,” a free, online publication.
- National Institute on Alcohol Abuse and Alcoholism (NIAAA). The Cool Spot, a website with information and resources about alcohol and resisting peer pressure.
- Partnership for Drug-Free Kids, a nonprofit dedicated to reducing teen substance abuse and helping families impacted by addiction.
- Texas Department of State Health Services. Prevention Resources for Teens web page, which lists relevant websites and fact sheets.
- Texas Department of State Health Services. YesQuit website. A wealth of resources for smokers who want to quit, including the toll-free Texas Quitline at: 877-937-7848 (877-Yes-Quit) for confidential counseling and support.
- U.S. Food and Drug Administration, online guide for families about how best to dispose of old medications: Disposal of Unused Medicines: What You Should Know.
The medical definitions provided in this module were obtained or adapted from the National Academy of Sciences, the National Institute on Drug Abuse, and the U.S. Department of Health and Human Services.
Related coursesCE Credit
Identifying and Treating Young People with High-Risk BehaviorsCE: 2.0Learn about the prevalence, signs, symptoms, and interventions for substance use and other risky adolescent behaviors.CE Credit
Teen Consent and ConfidentialityCE: 1.5Establish practice guidelines that comply with legal requirements for obtaining consent and maintaining confidentiality in providing health-care services to adolescents.CE Credit
Motivational InterviewingCE: 1.0Gain communication skills that can be used in the primary care setting to motivate children, adolescents, and families to make positive health changes, improve self-care for chronic conditions, and avoid high-risk behaviors.CE Credit
Interpersonal Youth ViolenceCE: 1.75Implement strategies to identify, intervene in, and prevent behaviors such as bullying, self-injury and suicide, dating violence, and sexting. Includes guidelines for ethically responding when an adolescent patient perpetrates violence.CE Credit
Promoting Adolescent HealthCE: 1.5Adopt best practices for adolescent screening, including recommended schedules, effective communication, and enhanced clinical procedures. Includes video examples of effective screening techniques.CE Credit
Introduction to Screening, Brief Intervention, and Referral to Treatment (SBIRT)CE: .5Learn how to conduct SBIRT in the medical office: instituting routine screening, early intervention, and referral to treatment for adolescent patients with substance use disorders or at risk for developing such disorders. Provides resources for obtaining mandatory SBIRT training.CE Credit
Preconception and Prenatal Health: Identifying and Intervening in High-Risk BehaviorsCE: 1.5Learn how high-risk behaviors can affect the health and pregnancies of girls and women of reproductive age, and how to assess risky behaviors that may contribute to an unintended pregnancy.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.