Letís take a quick look at how other states deal with the issue of employing only credentialed behavioral health care professionals in performing screening and initial assessment.
Some screening activities are mandated by the Federal Health Care Financing Administration (HCFA) without requiring credentialed behavioral health professionals, so long as the state stipulates a uniform approach in the state Medicaid plan. For example:
Since 1989, when EPSDT (Early Period Screening Diagnosis and Treament) was mandated by HCFA, trained personnel in behavioral health and non-behavioral health have been engaged in screening pursuant to a state plan approved by HCFA. These include school nurses, pediatricians, childrenís service system members and other healthcare professionals.
The Pre-Admission Screening and Referral process mandated by the federal 1989 Nursing Home Reform Act for the aged as well as persons with mental illness or mental retardation can be administered by both behavioral health and non-behavioral health personnel with appropriate training.
Some states and localities have standardized screening and assessment, although standardized screening is more common than standardized assessment. The latter is implemented more often in counties or regions, rather than on a statewide basis. Qualifications of personnel are based on state certification standards, which vary from state to state. Here are a few examples:
Ohio. The state Department of Mental Health Outcomes Project has uniform tools for screening, as well as assessment tools for children and adults that can lead to determination of medical necessity, level of care and service outcome.12 Ohio allows non-Masterís level personnel to perform the tasks as long as they meet state certification requirements. The uniform tools are being piloted in Ohio.
Missouri. The public alcohol and addiction services system uses uniform screening and initial assessment for determination of levels of care.13 The state is also in the process of developing integrated initial assessment for mental health and addiction services.
New Mexico. A common screening tool is used at the regional level.
Montgomery County, Ohio. A standardized and integrated screening and initial assessment tool for individuals with mental health and substance abuse needs has been in place since 1997.
Iowa. The Clinical Assessment and Consultation Teams (CACTs) permit completion of screening (including screening for risks) and initial assessment by referring childrenís agencies. However, only the credentialed staff of CACTs use the screening and assessment information to make a final determination on level of care.14
In-service training is sometimes arranged for those without the required behavioral health credentials in order to perform certain basic functions, including screening and assessment. For example:
The Walker Tireschman Center has piloted a regional training academy in the New England area to target direct care personnel in children services.
The New York State Office of Mental Health has collaborated with Hunter College School of Social Work in training and certifying Intensive Case Managers without requiring behavioral health credentials.15
In Maine, the Behavioral Health Sciences Institute at Southern Maine Technical College serves as a training resource to the public and private behavioral health industry.
As for the length of time taken by credentialing boards to complete the certification process, Oregon has a three-week turn-around time for administrative review, and Ohio provides a provisional and temporary status within seven to ten days as part of the initial administrative review, and offers state exams every two to three months.16