CE/CME

Behavioral Health: Screening and Intervention

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).

Credit Hours: 1.25 CE

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Goal

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.

Target Audience

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:

  1. Specify risk factors and diagnostic criteria for common behavioral and emotional disorders.
  2. 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.
  3. Integrate age-appropriate anticipatory guidance and evidence-based prevention strategies into clinical practice.
  4. Summarize the primary care provider’s role in coordinating care for children and adolescents with behavioral health disorders.

For purposes of this module,

  • 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.

Resources and links mentioned in this module can be found in the Appendix/Resources tab that can be accessed from this page.

Please note this module expires on 3/20/2027.

This module was released on 3/20/2024.

Featured

American Academy of Child and Adolescent Psychiatry, American Academy of Family Physicians, American Academy of Pediatrics, et. al. Child and Adolescent Mental Health. (2023). Child and Adolescent Mental and Behavioral Health Principles.

American Academy of Child & Adolescent Psychiatry.

American Academy of Child & Adolescent Psychiatry. Recommendations for Pediatricians, Family Practitioners, Psychiatrists, and Non-physician Mental Health Practitioners. When to seek referral or consultation with a CAP. (n.d.).

American Academy of Child & Adolescent Psychiatry. (2023). Workforce Maps by State (Texas).

American Academy of Pediatrics. Patient Care. (2023). Clinical Pathways for Suicide Prevention.

American Academy of Pediatrics. (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 144 (4): e20192528.

American Academy of Pediatrics. (n.d.) HealthyChildren.org. (2023). Suicide Prevention: 12 Things Parents Can Do.

American Academy of Pediatrics. (n.d.) HealthyChildren.org. (2019). Anxiety in Teens is Rising: What’s Going On?

American Academy of Pediatrics. Policy Statement. (2019). Mental Health Competencies for Pediatric Practice. Pediatrics. 144(5): e20192757.

American Academy of Pediatrics. (2021). AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health.

American Psychiatric Association. (rev. 2021). What are Disruptive, Impulse Control and Conduct Disorders?

American Psychiatric Association. (2023). What are Eating Disorders?

American Psychiatric Association. (2018). Stress in America: Generation Z.

Arakelyan, M., Freyleue, S., Avula, D., McLaren, J.L., O’Malley, A.J., Leyenaar ,J.K. (2023). Pediatric Mental Health Hospitalizations at Acute Care Hospitals in the US, 2009-2019. JAMA. 329(12):1000–1011.

Arnon, S., Brunstein Klomek, A., Visoki, E., et al. Association of Cyberbullying Experiences and Perpetration With Suicidality in Early Adolescence. (2022). JAMA. 5(6):e2218746.

Birdsey ,J., Cornelius, M., Jamal, A., et al. Tobacco Product Use Among U.S. Middle and High School Students — National Youth Tobacco Survey, 2023. (2023). Centers for Disease Control and Prevention. 72(44);1173–1182.

Boston University, Center for Anxiety & Related Disorders. (n.d.). Specific Phobias in Children and Adolescents.

Butter, E.M. Primary Care Pediatricians as a Solution to Increasing Treatment of Anxiety and Depression. (2023). Pediatrics, 151(5): e2022060877.

Centers for Disease Control and Prevention. Curtin, S. C., & Heron, M. (2019). Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017.

Centers for Disease Control and Prevention. (2023). Data & Statistics on Autism Spectrum Disorder.

Centers for Disease Control and Prevention. Children’s Mental Health. (2023). Data and Statistics on Children’s Mental Health.

Centers for Disease Control and Prevention. Children’s Mental Health. (2023). Therapy to Improve Children’s Mental Health.

Centers for Disease Control. Youth Risk Behavior Surveillance System. (2023). Youth Risk Behavior Survey 2021 Results

Centers for Disease Control and Prevention. Injury Prevention & Control. (2023). WISQARS™ — Web-based Injury Statistics Query and Reporting System.

Hink A.B., Killings, X., Bhatt, A., Ridings, L.E., & Andrews, A.L. (2022). Adolescent Suicide-Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. Current Trauma Reports. 8(2):41-53.

Hua, L.L., Lee, J., Rahmandar, M.H., Sigel, E.J. COMMITTEE ON ADOLESCENCE, COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION. (2024). Suicide and Suicide Risk in Adolescents. Pediatrics, 153 (1): e2023064800.

Maenner M.J., Warren Z., Williams A.R,. et al. (2023). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). 72(2):1–14.

National Institute of Mental Health. (n.d.). Child and Adolescent Mental Health.

National Institute of Mental Health. (n.d.). Eating Disorders.

National Institute of Mental Health. (n.d.). Schizophrenia.

National Institute of Mental Health. (2021). Children and Mental Health: Is This Just a Stage?

National Institute of Mental Health. (2023). Depression.

Irfan, N., Nair, A., Bhaskaran, J., Akter, M., & Watts, T. (2022). Review of the Current Knowledge of Reactive Attachment Disorder. Cureus, 14(11): e31318.

Lester, T.R.; Herrmann, JE.;. Bannett, Y.; Gardner, R.M.; Feldman, H.M.; Huffman L.C. Anxiety and Depression Treatment in Primary Care Pediatrics. (2023). Pediatrics, 151 (5): e2022058846.

Oliver, B., Jones, S., Hops, E., Ashley, C., Miech, R., Mpofu, J. (2023). Electronic Vapor Product Use Among High School Students — Youth Risk Behavior Survey, United States, 2021. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). 72(1):93–99.

Rebuli, M. E., Rose, J. J., Noël, A., Croft, D. P., Benowitz, N. L., Cohen, A. H., Goniewicz, M. L., Larsen, B. T., Leigh, N., McGraw, M. D., Melzer, A. C., Penn, A. L., Rahman, I., Upson, D., Crotty Alexander, L. E., Ewart, G., Jaspers, I., Jordt, S. E., Kligerman, S., Loughlin, C. E., … Witek, T. J., Jr. (2023). The E-cigarette or Vaping Product Use-Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An Official American Thoracic Society Workshop Report. Annals of the American Thoracic Society, 20(1), 1–17.

Society of Clinical Child and Adolescent Psychology. Effective Child Therapy: Evidence-based mental health treatment children and adolescents. (2017). Applied Behavior Analysis.

Substance Abuse and Mental Health Services Administration. (2016). DSM-5 Changes: Implications for Child Serious Emotional Disturbance.

Substance Abuse and Mental Health Services Administration. (2021). 2021 National Survey on Drug Use and Health (NSDUH): Model-Based Estimated Prevalence For States.

Texas Department of State Health Services. (2021). Youth Risk Behavior Survey (YRBS).

Texas Health and Human Services Commission. (2019). Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th version) .

Texas System of Care. Cartoon: Children’s Mental Health Texas. (n.d.). About Us.

Texas Workforce Commission. (n.d.). #One Pill Kills: Fentanyl Facts.

U.S. Health and Human Services. Data Resource Center for Child & Adolescent Health. National Survey of Children’s Health (2016 - present).

Wang S., Li Q., Lu J., et al. Treatment Rates for Mental Disorders Among Children and Adolescents: A Systematic Review and Meta-Analysis. (2023). JAMA Network Open, 6(10):e2338174.

Yang, H. How to approach feeding difficulties in young children. (2017). National Library of Medicine. Korean Journal of Pediatrics, 60(12):379-384.

Youth.gov. Mental Health. (n.d.).

Definitions

The medical definitions provided in this module were obtained or adapted from the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration (SAMHSA), Merriam-Webster, the Mayo Clinic and the National Institutes of Health.

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 1.25 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 1.25 contact hour(s) of Continuing Nursing Education.

Social Workers

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 1.25 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.

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 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

Disclosure - BHSI 2021

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. 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.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. 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
  4. 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.
  5. 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).

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Health-Care Providers

General Mental Health Resources

Anti-bullying

Perinatal Mental Health and Postpartum Depression

Suicide Prevention and Treatment

Texas Mental Health Programs and Services