Screening and Assessment Practices for Mental Health
by Jim O'Brien, Program Specialist, Health and Disabilities Branch, Head Start Bureau

The purpose of mental health screening is to ensure prevention and early identification of mental health problems that may interfere with a child's development. The comprehensive screening provided for each head Start child should include procedures to identify children who appear to be experiencing emotional and behavioral problems that may require specific intervention.

Your program should work with your mental health consultant to determine the instruments that may be most appropriate for the population you serve. Screening for mental health problems of children should:
  1. Be conducted with consultative or direct guidance from the mental health professional, as required by the Head Start Program Performance Standards;
  2. Tap multiple sources of information on the child's social and emotional development status, including input from family members and teaching staff who are familiar with the child's typical performance;
  3. Use age -appropriate and technically sound screening instruments designed and validated for the purpose screening for mental health problems of young children;
  4. Employ procedures that are culturally appropriate for the children being served;
  5. Provide clear guidance for program staff on the next steps to be undertaken for children whose screening results indicate the need for further assessment; and
  6. Provide opportunities for staff and families to periodically reconsider the needs of children after the initial screening and request further assessment if needed

In addition to developmental screening, the mental health needs of some children may be identified by parent report, teacher or Head Start mental health professional observations, or referral from an outside agency, such as a report from Child Protective Services. The following are some warning signs for children at risk for mental health problems:

  • Extremely active
  • Doesn't play
  • Very aggressive
  • Extremely dependent
  • Inappropriate emotional responses to situations
    (e.g., laughs when hurt)
  • Extreme mood swings
  • Fearful
  • Withdrawn
  • Sudden behavior changes
  • Very sad
  • Destructive

All of these behaviors occur occasionally in young children. They signal a problem when they occur frequently and are present for an extended period of time.

When children with mental health needs are identified, the next step is a timely referral for more comprehensive assessment by a qualified professional. For example, the screening procedure may indicate that, based on teacher and parent report, a child is aggressive with his peers at a level and frequency beyond that expected for his age. A more comprehensive assessment will be needed to define possible causes or influences upon the behavior. The assessment should lead to a plan for addressing the problem, helping parents with behavior management skills, or consulting with teachers about providing attention for more appropriate behaviors.

An effective and efficient mental health screening and assessment process requires a collaborative approach within and beyond the Head Start program. Head Start component staff and, most importantly, the child's parents, have information to contribute in the identification of children experiencing mental health problems. The programs must then secure appropriate interventions for these children. A screening and assessment process that yields the guidance to parents and Head Start staff on how to meet the mental health needs of children performs a critical role in providing brighter futures for Head Start children and their families.

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