An effort to expand the psychiatric services market to children in Massachusetts is now underway. This despite the horrific death of young Rebbecca Riley due to overdoses of psychiatric drugs.
This is part of a court ordered remedy due to another psychiatric screwup. Unfortunately, the inappropriate answer ordered was more psychiatry. Inappropriate due to the woeful track record of psychiatry, especially as documented on this site.
As seen in this report.
As of Monday, annual checkups for the nearly half a million Massachusetts children on Medicaid will carry a new requirement: Doctors must offer simple questionnaires to detect warning signs of possible mental health problems, from autism in toddlers to depression in teens.
The checklists vary by age but ask questions about children's behavior - whether they are spending more time alone, seeming to have less fun, having trouble sleeping - that are designed to trigger discussion between parents and doctors. The conversations may or may not lead to a referral to a specialist.
Over the last several years, such questionnaires have increasingly become the standard of care in pediatric practices, but - spurred by legal action - Massachusetts is jumping ahead of other states by requiring the screens for all its young Medicaid recipients.
The new requirement represents "a huge step forward in a direction that is a national trend," said Dr. Robin Adair, a University of Massachusetts Medical School pediatrician and screening specialist.
Supporters say the screening can catch issues earlier, before they develop into hard-to-manage crises.
Skeptics warn that more children could end up on heavy-duty medications that they don't really need.
"In a more perfect world, screening for mental illness amongst children would clearly be a good idea," said Dr. John Abramson, a clinical instructor at Harvard Medical School and author of "Overdosed America."
"But let's look at the realities of the world we live in," he said. "What happens is that there's a very quick translation of mental health symptoms into drug treatment."
Others wonder how Massachusetts' overburdened mental health system for children will handle the new patients the screening is expected to identify.
Already, children's psychiatrists and psychologists are often overbooked. Children with serious mental illness sometimes end up stuck in psychiatric hospitals for lack of mental health services in the community.
If, as expected, the new screening requirement turns up more children with mental health problems, "I do think it creates a potential additional access problem," said Dr. David DeMaso, chief of psychiatry at Children's Hospital Boston.
The new screening requirement stems from a lawsuit, Rosie D. v. Romney, that accused the state of falling down on its obligations to poor, mentally ill children. The federal judge in the case ruled in January 2006 that Massachusetts must improve its care, and the new requirement is the first step in the state's court-ordered remedy plan.
Families may decline the screening if they wish. If a screen turns up signs of potential trouble, it is also up to the family whether to pursue further help and an official diagnosis.
The new requirement applies to the 460,000 children and young adults covered by MassHealth, the state Medicaid program, at annual checkups from birth to age 21.
The state's private insurers generally already reimburse children's doctors for such written screens, and Medicaid will now pay $9.73 to cover the testing.
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As the routine screening gets underway, the state will be tracking how many children are tested and how many screens indicate a need for follow-up, said Emily Sherwood, who is overseeing the state's remedy for the Rosie D. case as director of its Children's Behavioral Health Interagency Initiatives. The state also plans to expand mental health services for children and make them more family friendly.
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