Policy Brief: Mental Health Screening and Beyond: Recommendation for Expansion

TEAM UP for Children applauds MassHealth’s innovative policy changes that focus on supporting comprehensive clinical services for children and families, including behavioral health services. In the spirit of our continued collaboration in the shared goal of ensuring children and families across the Commonwealth have prompt access to high-quality behavioral health care, TEAM UP is sharing our latest policy brief, “Mental Health Screening and Beyond: Recommendation for Expansion.”

Policy Brief: Mental Health Screening and Beyond: Recommendation for Expansion

Recommendation: TEAM UP for Children recommends that policymakers expand preventive behavioral health coverage to all children whose providers identify a need rather than defining eligibility based solely on a positive screening result.

The role of screening in access to care

Developmental and behavioral screening has long been recommended as an effective means to identify children with mental health care needs. However, connecting children to appropriate services has historically required a documented mental health diagnosis. Recognizing that the need for a diagnosis can serve as a barrier to preventive care, groundbreaking policy innovations have begun to require only a positive screening result to reimburse for treatment. This Policy Brief considers the potential benefits of this policy innovation and also how it might unnecessarily limit care and potentially exacerbate health disparities. Instead of relying solely on a screening result, TEAM UP for Children, an initiative that builds the capacity of pediatric primary care to deliver high-quality, evidence-based integrated behavioral health services, recommends that service eligibility should be expanded to include medical providers’ identification of need.


    • Screeners help providers identify children who need services. They flag children with nearly three times the chance of having a mental health need than other children.

    • Conservative estimates suggest that at least 1 in 5 children (20%) has a mental health concern. Yet, in the TEAM UP project, only 8.3% of children score positive on a validated screener (see Figure).

    • Many children who would benefit from early, preventive behavioral health services do not screen positive. Thus, reliance on screeners alone to identify children at risk will miss many children in need.

    • When providers identify mental health concerns, families accept additional services at a high rate— regardless of whether their children initially screened positive or negative.

Children’s mental health crisis

Children and adolescents are in desperate need of mental health services. We are in the midst of a National State of Emergency in Children’s  Mental HealthSuicide is the 2nd leading cause of death among people aged 10-34. Nearly 1  in 5 children suffers from mental health issues; however, only 20% receive treatment from a mental health provider. The average delay from the onset of symptoms to treatment is 11 years.

In 2021, MassHealth, the health insurance provider to the Commonwealth’s structurally marginalized residents, made a policy change to extend coverage for behavioral health services to children under 21 without requiring that children be formally diagnosed with a mental health disorder; instead, only a positive screening result (which reflects an elevated risk of a mental health problem) is currently required. This change allows children beginning to experience serious symptoms to receive treatment before they experience the effects of a full mental health disorder. We applaud this effort to support early and preventive intervention before children experience the impairment that mental health disorders so often entail.

However, coverage for preventive behavioral health services still requires a positive result on a screening tool. Using screening tools as the sole gateway for preventive services may have unanticipated effects that run counter to the intention behind the policy change. Using data collected from TEAM UP health centers and an illustrative case study, we demonstrate that reliance on screening tools to access preventive services can inadvertently exclude children who would benefit from care.

>> Continue reading the full policy brief,  “Mental Health Screening and Beyond: Recommendation for Expansion.