Universal Mental Health Screening of Children and Youth

Exploring opportunities for mental health screenings in schools

Universal Screening for Early Intervention

Between 50 and 75 percent of mental health symptoms begin during youth and young adulthood. In California alone, at least one in every three people between the ages of 12 to 17 report having a significant mental health challenge. Yet, the mental health needs of young people are frequently undetected and unsupported. The consequences of such oversight can be dire, even fatal.

A slew of evidence confirms that a young person living with unaddressed mental health needs is more likely to experience social, economic, and health-related challenges later in life – shortening their life expectancy by 10 to 20 years. In the short term, a lack of mental health support leads to suffering and in the worst case, can result in school failure, substance abuse, and suicide for young people.

Fortunately, when a person’s mental health needs are identified and supported early their outcomes greatly improve. Screening for unmet mental health needs, particularly when people are young, is a key strategy for promoting early intervention. Settings in which young people routinely engage, such as doctors’ offices and schools, are considered opportune settings for routine health screenings. Yet, screening practices are highly underutilized for mental health compared to physical health needs.

Goal/Opportunity

The Legislature requests the Commission, on or before March 1, 2024, and in consultation with the Department of Health Care Services to the extent feasible, submit a report to the legislature on universal mental health screenings of children and youth. It is the intent of the Legislature that the report may be used to inform future budget and policy considerations around expanding mental health screenings to children in California, with the goal of reducing adverse health and life outcomes later in life stemming from unaddressed mental health challenges.

Goals for this project include:

  • Instilling a shared understanding of universal mental health screening policies and best practices for children and youth, and their effectiveness in preventing the adverse outcomes of unaddressed mental health needs.
  • Understand the landscape of youth mental health screening policies and practices in California, including the strengths and challenges of existing models, and barriers to scaling.
  • Identify the legal, fiscal, and capacity needs for implementing universal mental health screening in California schools.

 

Objectives:

  • Provide a summary of existing research on universal mental health screening policies, with clear definitions and with consideration of cost and efficacy of screening tools, best practices, and how they are administered across various healthcare and school settings and across age groups.
  • Assess and describe existing mental health screening policies and practices in California including Medi-Cal, other DHCS programs, the Children and Youth Behavioral Health Initiative, and other non-Medi-Cal screening programs, with a focus on strengths, challenges, and lessons learned from existing models.
  • Assess and describe the legal, fiscal, and capacity needs and considerations for school-based mental health screening, including those related to parental notification and consent, data security and privacy frameworks necessary to maintain confidentiality of screening results, and funding opportunities to cover the costs of administering universal mental health screenings in schools.

Background

Under Governor Newsom’s administration, California has made monumental investments to better support the mental health of its young population. Through initiatives such as the Youth Behavioral Health Initiative, the Mental Health School Services Act, and its modernized public healthcare system known as CalAIM, the state is building a full continuum of infrastructure and service systems that emphasize prevention and early intervention. California’s leaders recognize the role of mental health screening to support this continuum and want a path forward.

The Legislature requested the Commission to report information and make recommendations to the state and Legislature related to universal mental health screening of children and youth by March 1, 2024. The Legislature allocated $200,000 to support Commission activities in pursuit of these goals.

Expected Outcomes

The Commission will engage in research and review and outreach and engagement before creating a final report. The research and review phase will produce a literature review, an overview of existing mental health screening policies and the degree of utilization across California school and healthcare settings (both Medi-Cal and non-Medi-Cal), and case studies describing universal screening programs administered by local governments, states, or other countries. The outreach and engagement phase will include interviews with parents, students, local partners, and state agency and legislative partners, an online survey of a representative sample of California schools to learn about their current universal screening practices, and site visits.

A final report, with a summary of findings and recommendations to satisfy the requirements of the Legislature’s request outlined above. The legislature has agreed to a phased approach for delivering the final report.

  • Phase 1 – on March 1, 2024, the commission will submit a report containing a comprehensive summary of existing research and information on universal mental health screening models, policies, and practices.
  • Phase 2 – in August 2024, the commission will deliver a final report and landscape analysis that incorporates findings from the statewide survey and community engagement activities to identify best practices, costs, and barriers to implementing universal screening practices in California K-12.

Drafts of the report at each phase will be presented to the Commission for their consideration of adoption prior to delivering the report to the legislature.

Project Milestones

  • September 2023 – Project Kickoff – Project kickoff during MHSSA workgroup meeting- panel presenters on universal screening in California.
  • October 2023 – Stakeholder Engagement – MHSOAC staff presented at the Jewish Family Partnership, Pupil Services Coalition meeting.
  • December 2023 – Site Visit – Site visit to Feaster Charter School in Chula Vista San Diego to learn about their universal mental health screening model.

Next Steps

  1. Complete Community Engagement Activities

    Research and community engagement activities are underway to support the development of the Commission’s Phase 2 report.
  2. Complete Phase 1 Report

    Present Phase 1 report with literature review summary to the Commission for adoption and delivery to the Legislature.
  3. Complete Phase 2 Report

    Present Phase 2 report with survey findings and landscape analysis to the Commission for adoption and delivery to the Legislature.