Meeting Children Where They Are: Mental Health Screening and Early Intervention Policies

Five Things to Know About Child and Adolescent Mental Health

• Mental Health Remains a Challenge for Youth. About 50% of lifetime mental illness begins by age 14, and 75% begins by age 24, according to a study in the Journal of the American Academy of Child and Adolescent Psychiatry. While rates of poor mental health among youth have declined since peaking in 2021, the most recent Youth Risk Behavior Survey from the Centers for Disease Control and Prevention found that 40% of youth reported persistent feelings of sadness or hopelessness, 20% seriously considered suicide and 9% attempted suicide within the last year.

• Poor Mental Health Can Impact Overall Well-Being and Learning. Untreated mental health problems in childhood or adolescence are associated with lower academic achievement, increased likelihood of engaging in high-risk behaviors and greater likelihood of mental health challenges in adulthood. Adverse childhood experiences, also known as ACEs, such as abuse and neglect, may also significantly increase the risk of lifelong behavioral health struggles, according to the CDC.

• Access Gaps Remain in Mental Health Care for Children and Adolescents. Surgo Health's Youth Mental Health Tracker reports that 45% of surveyed young people experienced mental health struggles in the past two years that made daily activities more difficult, yet nearly 40% of them never received mental health care. Research from the journal Child and Adolescent Psychiatry and Mental Health suggests that stigma, cost, transportation challenges and limited mental health literacy may present barriers for youth seeking mental health support.

• Schools Can Play a Key Role in Screening. According to the National Center for Education Statistics, nearly 20% of all public school students have received some type of mental health service at school. Research from Health Affairs suggests that school-based services can reduce access barriers, particularly for students from low-income households and those in rural areas. Students who receive these services are reported to be six times more likely to access needed support compared with students who receive services outside of school, according to the U.S. Department of Education.

• Screening and Early Intervention May Reduce Costs. The National Academies of Sciences, Engineering and Medicine estimate that every dollar invested in mental, emotional and behavioral health prevention yields $2-$10 in lifetime savings across health care, child welfare and economic productivity. A Journal of the American Medical Association study found that universal routine depression screening in primary care for adolescents is often recommended and is a cost-effective option because it can connect children to services before mental health needs escalate.

Five State Strategies to Support Early Intervention and Prevention

• Establishing School-Based Mental Health Screening. States are increasingly establishing school-based screening frameworks to identify concerns early. Louisiana created a statewide framework allowing schools to provide mental health screenings for K-12 students during the first semester of each academic year. The law also requires departments of health and education to distribute approved screening tools and community resources to local school systems. Illinois established a universal student mental health screening program for students in grades three through 12, to be offered at least annually beginning with the 2027-2028 school year.

• Reimbursement for Screening and Prevention. States are using reimbursement policies to encourage early intervention in primary care and school settings. Arkansas established supplemental reimbursement rates for children's preventive services in primary care settings to incentivize medical homes and encourage early intervention through universal, team-based enhanced primary care services. Connecticut authorized Medicaid reimbursement for suicide risk assessments and other mental health evaluations at schools and school-based health centers.

• Leveraging EPSDT to Address Children's Mental Health. The federal Early and Periodic Screening, Diagnostic and Treatment, or EPSDT, benefit provides comprehensive and preventive health care for children under 21 enrolled in Medicaid. Maryland directed its youth behavioral health work group to recommend ways to implement EPSDT​ ​best practices,​ including services ​provided before a ​diagnosis and the feasibility of implementing a diagnostic tool for patients younger than 5. Colorado​ ​authorized coverage of select behavioral health services for children using Z codes, allowing care before a formal diagnosis. The state's Medicaid agency recently recommended maintaining the policy as an effective early intervention strategy.

• Early​ Intervention in Child Welfare. States are embedding trauma-informed assessments and services into child welfare processes. Florida required that children removed from their homes receive a trauma-focused assessment as soon as possible but no later than 14 days after a shelter hearing. The assessment must ensure prompt referral to appropriate trauma services, including clinical evaluation and intervention if needed. North Carolina required that, to receive state funding, children's advocacy centers must provide a child-friendly, trauma-informed environment and maintain a multidisciplinary team capable of delivering or referring children to trauma-focused, evidence-supported mental health treatment.

• Building Workforce Capacity for Primary Prevention. Several states are working to strengthen the prevention workforce and expand access to early childhood mental health expertise. Virginia will convene a work group to develop a mental health screening and assessment tool for young children and to provide consultation, training and resources to early childhood educators, pediatric providers and families. Montana created a committee to conduct a statewide inventory of primary prevention programs and workforce capacity. The committee will also outline projected funding of prevention efforts, assess the adequacy of the state's higher education system to train and educate professionals to meet the state's prevention needs, and identify where the Legislature is best poised to address gaps.