Case Study

Mental Health Screening for Adolescents

As you enter the exam room to talk privately with 15-year-old Evelyn as part of her Texas Health Steps preventive medical checkup, you see the girl brush away tears. “Oh, sorry,” she says. “I need to get it together today.” You pull up a stool, sit at eye level, and offer her some tissues. “There’s no need to apologize,” you say. “I’d like to know what’s causing you to cry.” You wait patiently as Evelyn blows her nose and takes a moment to decide what to say. In the silence, you make a mental note of faint parallel scars on her inner arm, a potential sign of cutting, a form of non-suicidal self-injury.

“There’s lots of drama at my house since my parents split up,” she says finally. “I’d talk to my friends, but they have drama, too. They’re too involved with their problems to care about mine. Nobody seems to care much about me. Some days that bothers me a lot … I guess this is one of those days.”

When Evelyn finishes speaking, you thank the girl for sharing her situation and acknowledge her challenges. “The changes in your family and friend group sound difficult,” you tell her. “One thing I do with my teenaged patients is to go through some questions to help me better understand their situation and how I can help. Is it okay for us to go through the questions?”

Evelyn agrees to participate, and you perform a mental health screening. Read the steps below for more information about Texas Health Steps recommendations for adolescent mental health screening.

portrait of teen girl

Mental health screening is a required component of every Texas Health Steps preventive medical checkup. Texas Health Steps strongly encourages providers to meet this screening requirement by annually screening adolescents 12 through 18 years with a validated, standardized mental health screening tool approved by Texas Health Steps.

Health-care providers who use one or more of the validated, standardized mental health screening tools approved by Texas Health Steps can receive reimbursement once per calendar year if the screening is performed during a Texas Health Steps checkup. Providers should use procedure code 96160 or 96161 when completing a mental health screening during an annual preventive medical checkup for an adolescent age 12 through 18 years.

Texas Health Steps approves seven validated, standardized screening tools for adolescent mental health screenings. The screening tools are:

  1. Pediatric Symptom Checklist (PSC-17)
  2. Pediatric Symptom Checklist (PSC-35)
  3. Pediatric Symptom Checklist for Youth (Y-PSC)
  4. Patient Health Questionnaire (PHQ-9)
  5. Patient Health Questionnaire Modified for Adolescents (PHQ-A [depression screen])
  6. Patient Health Questionnaire (PHQ-A [anxiety, eating problems, mood problems, and substance use])
  7. Car, Relax, Alone, Forget, Family, and Trouble Checklist (CRAFFT)

As Evelyn’s medical home provider, you are prepared to take appropriate action based on the results of the mental health screening. Your next step may include supporting her in a difficult but normal stage of adolescent development, referring her to a mental health specialist or school or community resource, or managing her diagnosis and ongoing care in your office.

Why It Matters

Adolescence is a time of key emotional development, and girls are three times more likely than boys to be diagnosed with depression. The American Academy of Pediatrics recommends annual mental health screening for adolescents. Texas Health Steps requires mental health screening at all checkups birth through 20 years of age, and strongly encourages providers to complete mental health screenings for adolescents 12-18 years of age using one of the screening tools approved by Texas Health Steps.

Primary care clinicians can integrate adolescent mental health screening at all clinical encounters using a choice of multiple validated, standardized screening tools. Untreated anxiety and depression can cause impairments and distress to adolescents as well as the potential for lifelong problems. Primary care clinicians can help by screening for emotional and behavioral disorders, collaborating with parents, and treating or referring adolescents for appropriate care.

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