Behavioral/Mental Health and Substance Use Screening & Referral for Older Adults

Complete age-appropriate screening for mental health and substance use in older adults, as well as screening and referral to treatment and/or referral to appropriate social services, and document this in patient care plans.

Evidence of documented screening for mental/behavioral health and substance abuse for older adults with evidence of treatment and/or referral to appropriate social services established in the care plan. Include the following elements:

1. Identification of older adult population with mental/ behavioral health and substance use concerns – Report from the electronic health record (EHR), qualified clinical data registry (QCDR), clinical registry, or other system demonstrating tracking of older adults with behavioral/mental health and or substance abuse; AND

2. Evidence of behavioral/mental health and substance use disorder (SUD) screening - Report from EHR, QCDR, clinical registry, or documentation from medical record chart showing regular practice for screening for behavioral/mental health and substance use disorder; AND

3. Evidence of appropriate treatment and/ or referral documented in care plan – Report from HER, QCDR, clinical registry, or documentation from a medical chart showing appropriate treatment and/ or referrals for behavioral/mental health concerns and substance use disorder.

Examples of screening tools:

- Patient Health Questionnaire (PHQ-9)

- Anxiety Disorder 7-item scale (GAD-7)