Welcome to the training on Behavioral Health: Screening and Intervention provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Notes: For purposes of this module,
- The term “serious emotional disturbance” (SED) is used to describe a range of mental, emotional and behavioral disorders.
- The term “children” broadly refers to children and adolescents ages birth through 20 years. The term “child” specifically applies to ages birth through 10 years and “youth” applies to ages 11 through 20 years, which is consistent with the Texas Health Steps Periodicity Schedule.
- The term “parent” includes guardians and caregivers.
The goal of this module is to equip Texas Health Steps providers and other interested health-care professionals to follow state requirements and best practices for psychosocial and behavioral health screening, diagnosis, and ongoing management in the primary care setting.
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:
- Specify risk factors and diagnostic criteria for common forms of serious emotional disturbance.
- Apply the requirements of the Texas Health Steps Periodicity Schedule to conduct age-appropriate mental health screening for children and adolescents ages birth through 20 years using approved tools.
- Integrate age-appropriate anticipatory guidance and evidence-based prevention strategies into clinical practice.
- Summarize the primary care provider’s role in coordinating care for children and adolescents with behavioral health disorders.
Please note this module expires on 3/16/2024.
This module was released on 3/16/2021.
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 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider 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 1.50 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 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 has the following relevant financial relationships to disclose:
- Steven Pliszka - Physician - Grants/Research Support for Otsuka Pharmaceutical - Consultant for Adlon Pharmaceutical - Speaker's Bureau for Ironshore Pharmaceutical
- 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).
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
- ADHD or Child Traumatic Stress? A Guide for Clinicians.
- American Academy of Pediatrics. (2019). Mental Health Competencies for Pediatric Practice. Pediatrics, 144(5), e20192757.
- Ask Suicide-Screening Questions (ASQ) Toolkit: Free resource that can help primary care providers identify youth at risk for suicide. From the National Institute of Mental Health (NIMH).
- Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition. (2017). From the American Academy of Pediatrics (AAP).
- CCP Prior Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services form.
- Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5). From the American Psychiatric Association.
- Facts for Families Guide: Information on a host of mental health-related topics. From the American Academy of Child & Adolescent Psychiatry (AACAP).
- Guideline for Prescribing Opioids for Chronic Pain: Recommendations for prescribing opioid pain medication for patients 18 and older in primary care settings. From the Centers for Disease Control and Prevention (CDC).
- HealthyChildren.org: Resources to support parents and promote positive parenting, including a Family Life section. From the AAP.
- Medications for mental health disorders: Learn more about commonly used medications for specific mental health disorders. From NIMH.
- MentalHealth.gov: Resources for mental health issues, including the basics, what to look for, talking about mental health and how to get help. From the U.S. Department of Health and Human Services.
- Mental Health Screening and Assessment Tools for Primary Care: Table of mental health screening and assessment tools, summarizing their psychometric testing properties, cultural considerations, costs and references. From the AAP.
- National Child Traumatic Stress Network: Is it ADHD or Child Traumatic Stress? A Guide for Clinicians.
- Patient-Reported Outcomes Measurement Information System (PROMIS): Set of freely available validated measures of physical, mental and social well–being. From the National Institutes of Health (NIH).
- Pediatric Symptom Checklist (PSC): Psychosocial screen to improve the recognition of cognitive, emotional and behavioral problems in children ages 4 to 16 years. The PSC consists of 35 items that are rated never, sometimes, or often. A “positive” score indicates the need for further evaluation and/or intervention. Youth-reported and parent-completed versions are available.
- The Texas Clinician’s Postpartum Depression Toolkit: Validated for use in PPD patients and available online. From HHSC.
- PTSD Fact Sheet from AAP.
- Standardized Assessment Tools: Free repository of available standardized tools to assess mental and physical conditions. From the National Cancer Institute (NCI).
- Substance Use Screening and Intervention Implementation Guide. From the AAP.
- Suicide Prevention Mobile Apps: Download the free ASK about Suicide and Hope Box apps. From the Texas Suicide Prevention Council.
- Children’s Health Insurance Program (CHIP): Designed for families with low incomes who lack access to health insurance and don’t qualify for Medicaid.
- Early Childhood Services (ECI): Diagnosis of a disability or developmental delay, including autism spectrum disorder (ASD), qualifies a child for ECI services through age 35 months. ECI Information for Health & Medical Professionals, including referral form.
- Mental Health First Aid (MHFA): Learn more about training and class availability from Texas local mental health authorities (LMHAs) and local behavioral health authorities (LBHAs). MHFA is a public health course for families and others that covers common risk factors and warning signs of mental health and substance misuse problems, including depression, anxiety and eating disorders. MHFA Youth is available for those who work with youth and tMHFA (Teen MHFA) is available for those who work with adolescents. There are in-person courses, all-virtual courses and blended courses (half in-person and half online) available.
- Stop Bullying Program: A federal government website managed by the U.S. Department of Health and Human Services.
- Texas Council of Community Centers: Community mental health services for adults and children is administered through 39 local mental health authorities (LMHAs) and local behavioral health authorities (LBHAs) throughout the state. The Texas Council represents and promotes the 39 community mental health centers.
- Texas Education Agency (TEA): In Texas, school district Preschool Programs for Children with Disabilities (PPCD) provide special education and related services for eligible children ages 3 through 5 years with disabilities. Eligible children may receive PPCD services in a variety of places.
- Texas Health and Human Services Commission (HHSC): Plays a major role in the funding and oversight of publicly funded mental health care, including coverage for mental health services for children through Medicaid and CHIP.
Texas Health Steps:
- The Texas Health Steps Periodicity Schedule, Child Health Clinical Health Records, Anticipatory Guidance, and other information and forms for health-care providers are available on HHSC’s Texas Health Steps web page for medical providers.
- Validated, standardized mental health screening tools approved by Texas Health Steps.
- Texas Medicaid: Delivered and managed through a variety of providers, including STAR Medicaid, STAR+PLUS Medicaid, STAR Kids managed care programs and Medicaid fee-for-service programs.
- Texas Medicaid & Healthcare Partnership (TMHP): Information for Medicaid providers, including the Texas Medicaid Provider Procedures Manual (TMPPM).
- Texas Mental Health and Substance Abuse Division (MHSA): Oversees the mental health system in Texas.
American Academy of Child & Adolescent Psychiatry (AACAP):
- Conduct disorder fact sheet. (2018).
- Oppositional Defiant Disorder fact sheet. (2019).
- When to seek referral or consultation with a CAP. (n.d.).
- Workforce issues. (2019).
- Workforce maps by state. (2018).
American Academy of Pediatrics (AAP):
- 10 things parents can do to prevent suicide. (2015). HealthyChildren.org.
- Policy Statement: Addressing early childhood emotional and behavioral problems. (2016). Pediatrics, 138(6), e20163023;
- American Academy of Pediatrics provides guidance on helping children with mental health challenges. (2019).
- Anxiety in Teens is Rising: What’s Going On?
- Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition. (2017).
- Calzo, J. P., Sonneville, K. R., Scherer, E. A., Jackson, B., & Austin, S. B. (2016). Gender conformity and use of laxatives and muscle-building products in adolescents and young adults. Pediatrics, 138(2): e20154073.
- Children's hospitals admissions for suicidal thoughts, actions double during past decade. (2017). AAP News.
- Policy statement: Firearm-related injuries affecting the pediatric population. (2012/2016). Pediatrics, 130(5).
- Policy Statement: Mental Health Competencies for Pediatric Practice. (2019). Pediatrics, 144(5), e20192757.
- How emotional and behavioral disorders are treated. (2015).
- Legalizing Marijuana Not Good for Kids: AAP Policy Explained. (2019).
- Mental health initiatives.
- Substance Use Screening and Intervention Implementation Guide.
- Survey: Suicide, suicidal ideation encountered often in pediatric practice. (2019). AAP News.
- Study: Gunfire kills or injures more than 7,000 children per year. (2017).
American Psychiatric Association (APA):
- Treating bipolar disorder in kids and teens. (2020).
- American Psychological Association. (n.d.). Children’s mental health.
- Anxiety and Depression Association of America. (2015). Childhood anxiety disorders.
- Anxiety Disorders Association of America. (n.d.). Anxiety Disorders in Children.
- Beidas, R. S., Stewart, R. E., Walsh, L., Lucas, S., Downey, M. M., Jackson, K., Fernandez, T., & Mandell, D. S. (2015). Free, brief, and validated: Standardized instruments for low-resource mental health settings. Cognitive Behavioral Practice, 22(1), 5–19.
- Boston University, Center for Anxiety & Related Disorders. (n.d.). Specific phobias in children and adolescents.
- Brady Campaign to Prevent Gun Violence. (2015). The truth about suicide and guns.
Centers for Disease Control and Prevention (CDC):
- Adolescent health. (n.d.).
- Attention-deficit/hyperactivity disorder (ADHD): Other concerns and conditions.
- Autism spectrum disorder. (2017).
- Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo, D. V., Warner, L., Folger, S., . . . Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. Morbidity and Mortality Weekly Report (MMWR), 69, 575–581.
- Creamer, M. R., Jones, S. E., Gentzke, A. S., Jamal, A., & King, B. A. (2020). Tobacco Product Use Among High School Students — Youth Risk Behavior Survey, United States, 2019.
- Curtin, S. C., & Heron, M. (2019). Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017.
- Data and statistics: Mental, behavioral, and developmental health of children. (2017).
- Depression among women. (2017).
- Guideline for prescribing opioids for chronic pain.
- High risk substance use among youth. (2020).
- Jones, C. M., Clayton, H. B., Deputy, N. P., Roehler, D. R., Ko, J. Y., Esser, M. B. . . . Hertz, M. F. (2020). Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students — Youth Risk Behavior Survey, United States, 2019.
- Kochanek, K. D., Murphy, S. L., Xu, J., & Arias, E. (2019). National Vital Statistics Reports: Deaths: Final Data for 2017.
- Post-traumatic Stress Disorder in Children. (2020).
- Smoking and tobacco use.
Child Mind Institute:
- Children’s Mental Health Report. (2020).
- How anxiety leads to disruptive behavior. (n.d.).
- Dabkowska, M., & Dabkowska-Mike, A. (2015). Risk Factors of Anxiety Disorders in Children.
- Everytown Research & Policy. (2019). Fact Sheet: The Impact of Gun Violence on Children and Teens.
- Goday, P., Huh, S., Silverman, A., Lukens, C., Dodrill, P., Cohen, S., … Phalen, J. (2019). Pediatric Feeding Disorder – Consensus Definition and Conceptual Framework. Journal of Pediatric Gastroenterology and Nutrition. 68(1), 124-129.
- Godoy, L., Hodgkinson, S., Robertson, H., Sham, E., Druskin, L., Wambach, C. G., . . . Long, M. (2019). Increasing Mental Health Engagement from Primary Care: The Potential Role of Family Navigation Pediatrics, 143(4), e20182418.
- Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali. M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2018). Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics, 20, 256-67.
- Ladores, S., & Corcoran, J. (2019). Investigating postpartum depression in the adolescent mother using three potential qualitative approaches. Clinical medicine insights: Pediatrics, 13.
- Lebel, C., Walton, M., Letourneau, N., Giesbrecht, G. F., Kaplan, B. J., & Dewey, D. (2016). Prepartum and postpartum maternal depressive symptoms are related to children’s brain structure in preschool. Biological Psychiatry, 80(11).
Mental Health America:
- Mental health information. (n.d.).
- Conduct disorder. (n.d.).
- The state of mental health in America. (2021).
- Merck Manual. (2019). Overview of mental disorders in children and adolescents.
National Alliance on Mental Illness (NAMI):
- Anxiety disorders. (2017).
- Mental health by the numbers. (n.d.).
- Binge eating disorder: Overview and statistics.
- Other specified feeding or eating disorders. (n.d.)
- National Institutes of Health (NIH). (2015). Patient-Reported Outcomes Measurement Information System (PROMIS).
National Institute of Mental Health (NIMH):
- Bipolar disorder in Children and Teens. (2020).
- Child and adolescent mental health. (2017).
- Eating disorders. (2017).
- Eating disorders: about more than food. (2018).
- Gordon, J., (2020). Piecing together the genetic puzzle of schizophrenia.
- Major depression. (2017).
- Mental illness. (2020).
- Perinatal depression. (n.d.).
- Schizophrenia. (2017).
- Postpartum Support International. (n.d.) Postpartum psychosis.
- Scheeringa, M. S., Zeanah, C. H., & Cohen, J. A. (2011). PTSD in children and adolescents: Toward an empirically based algorithm. Depression and Anxiety, 28(9), 770-782.
Substance Abuse and Mental Health Services Administration (SAMHSA):
- Adults with SMI and Children/Youth with SED. (n.d.)
- Center for Behavioral Health Statistics and Quality. (2016). DSM-5 changes: Implications for child serious emotional disturbance (unpublished internal documentation).
- Improving life outcomes for children with history of mental health challenges and trauma. (2018).
- Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. (2017).
- People at Greater Risk of Suicide. (2020).
- Substance use disorders. (2020).
- Texas Health and Human Services Commission (HHSC), Parameters Workgroup of the Psychiatric Executive Formulary Committee, Health and Specialty Care Division. (2019). Psychotropic medication utilization parameters for children and youth in Texas public behavioral health (6th version).
Texas Health and Human Services Commission (HHSC):
- Community Resource Coordination Groups (CRCGs) of Texas handbook. (2019).
- Texas Statewide Behavioral Health, Strategic Plan Update: 2017-2021. (2019).
- Texas Occupations Code, Sec. 159.005.
Texas System of Care. About us. (n.d.)
- The Incredible Years. (n.d.).
- Tobin, E. T., Hulkower, R. L., & Kaminski, J. W. (2017). Behavioral health integration in pediatric primary care: Considerations and opportunities for policymakers, planners, and providers. Milbank Memorial Fund report.
- Vo, M., Lau, J., & Rubinstein, M. (2016). Eating disorders in adolescent and young adult males: Presenting characteristics. Journal of Adolescent Health, 59(4), 397–400.
- Whitney, D. G., & Peterson, M. D. (2019). US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children. JAMA Pediatrics, 173(4), 389-391.
- Yang, H. (2017). How to approach feeding difficulties in young children. Korean Journal of Pediatrics, 60(12), 379-384.
The medical definitions provided in this module were obtained or adapted from the Substance Abuse and Mental Health Services Administration (SAMHSA), Merriam-Webster and the Mayo Clinic.
Teen Consent and Confidentiality
Establish practice guidelines that comply with legal requirements for obtaining consent and maintaining confidentiality in providing health-care services to adolescents.
Gain 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.