Columbia University TeenScreen Program

The Columbia University TeenScreen Program (CTSP) is an evidence-based, national mental health and suicide risk screening program. The program provides assistance in communities throughout the United States to establish early identification programs. Through these programs, families are offered the opportunity for their teen to participate in a screening for mental health problems, such as depression and other suicide risk factors. As of 2008, CTSP has over 500 active screening sites in 44 states in the U.S., plus 3 additional countries. Screening is voluntary and offered through schools, clinics, doctors' offices, juvenile justice facilities, and other youth-serving organizations and settings [http://www.teenscreen.org/our-local-programs]

Early mental health screening has been endorsed by former U.S. Surgeon General David SatcherU.S. Surgeon General (1999). "Mental Health: A Report of the Surgeon General." Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.] U.S. Public Health Service (2000). "Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda." Washington, DC: Department of Health and Human Services.] and the President’s New Freedom Commission on Mental Health.New Freedom Commission on Mental Health, "Achieving the Promise: Transforming Mental Health Care in America." Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.] The Columbia University TeenScreen Program is included as an evidence-based program in the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)'s National Registry of Evidence-based Programs and Practices (NREPP) [ [http://www.nrepp.samhsa.gov National Registry of Evidence-Based Programs and Practice] ] as a scientifically tested and reviewed intervention.

How CTSP is implemented

The Columbia University TeenScreen Program is implemented by creating partnerships with communities across the nation to set up local screening programs for youth. The majority of local TeenScreen programs are located in middle and high schools. Other communities have chosen to implement the program in doctors' offices, clinics and juvenile justice facilities.

After a parent has decided they would like their teen to participate and the youth has agreed to participate in the screening, CTSP asks teens to answer a short set of questions regarding different symptoms that occur in depressed or suicidal youth. This questionnaire is the first stage of the screening process. Teens that answer yes to more than a certain number of these questions advance to a short one-on-one interview with a mental health professional to follow up on the symptoms the teen endorsed and determine whether they are experiencing any impairment as a result of the symptoms. This second step of the program is where parents can find out whether their teen might benefit from a more in-depth assessment.

Only teens that indicate they might have a problem on the screening questionnaire and are deemed to be at risk by a mental health professional are considered to have “screened positive.” The parents of these teens are informed of the results and are offered a referral for a complete mental health evaluation. The Columbia University TeenScreen Program uses a questionnaire and interview process to see if a teen may be suffering from depression or other mental health problems. It is not a diagnosis. Treatment choices, if any, are left to parents. [http://www.teenscreen.org/screening-process]

Research

ome research on effectiveness

* Screening is an accurate predictor of mental health problems that may develop into more serious conditions. In a study examining young adults several years after they had participated in screening in high school, two-thirds of those who made a later suicide attempt or went on to experience a major depression in young adulthood had been identified as being at risk in high school.Shaffer D, Restifo K, Garfinkel R, Wilcox H, Ehrensaft M, Munfakh J. (1998). "Screening for young-adult suicidality and mood disorders in high school." Poster presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry; Anaheim, CA.]
* Clinicians in school-based health centers (SBHCs) using screening tools to assess students who present for services correctly identify three times the number of depressed youth, five times the number of anxious youth, and four times the number of youth with multiple disorders as compared to SBHC clinicians who do not use screening tools. [Levitt JM, WonPat-Borja A, Buffered S, Jensen P. (2004). "Implementing evidence-based assessment strategies in schools." Poster presented at the annual meeting of the American Psychological Association; Honolulu, HI.]
* Rates of self-reported suicide attempts decrease when screening is combined with education about suicide and its prevention. [Aseltine RH and DeMartino R. (2004). "An outcome evaluation of the SOS suicide prevention program." American Journal of Public Health; 94(3): 446-451. PMID 14998812]
* The U.S. Surgeon General has highlighted screening as an effective method of youth suicide prevention.
* The President’s New Freedom Commission on Mental Health places a high priority on the implementation of voluntary school-based screening programs.

ome research on safety

Mental health screening and directly asking youth if they are thinking about suicide or have made a prior suicide attempt does not put the idea of committing suicide in their heads, increase suicidal ideation, or create distress. [Gould M, Marrocco F, Kleinman M, Thomas J, Mostkoff K, Cote J, Davies M. (2005). "Evaluating iatrogenic risk of youth suicide screening programs: A randomized controlled trial." Journal of the American Medical Association; 293: 1635-1643. PMID 15811983]

* Teens who participated in screening did not have higher distress levels than teens who did not participate. This was true immediately after being screened and two days later.
* Screening participants did not have higher rates of depressive symptoms than non-participants
* Screening participants were not more likely to report suicidal ideation after completing the screening
* Depressed teens and previous suicide attempters who were screened were less distressed and suicidal than depressed teens and previous suicide attempters who were not screened

History

The Columbia University TeenScreen Program was created after a concerned father came to researchers at Columbia University and expressed an interest in the work being done there to identify youth at risk for suicide. Having experienced a death from suicide and mental illness in his own family, this parent decided to personally support Columbia’s efforts to offer mental health check-ups to families around the country, in the hope that others might be saved the pain experienced by his own family. As a result, pilot TeenScreen programs began in 1999 in Indiana, New Hampshire, and Oregon, with the Columbia University TeenScreen Program National Initiative launched in 2003. " [http://www.teenscreen.org/program-history] "

Debate

Some organizations that have strong feelings against mental health screening programs persist in claiming that the program is funded by drug companies or is trying to encourage anti-depressant use. Both of these assertions are untrue. The Columbia University TeenScreen Program is funded by private foundations, individuals, and organizations in support of the early identification of mental illness in youth and the prevention of teen suicide. This funding also allows for ongoing outreach to help develop and expand local CTSP programs. For every dollar of support provided to the National Columbia University TeenScreen Program, a local program attracts more than four times that amount in local donations, grants or in-kind support. [http://www.teenscreen.org/national-teenscreen-support]

Several federal programs, including the President’s New Freedom Commission on Mental Health and the Garrett Lee Smith Memorial Act, directly support local screening efforts; a number of state programs have also created unique partnerships to support screening at the community level. [http://www.teenscreen.org/federal-partnerships-and-support-for-suicide-prevention http://www.teenscreen.org/state-partnerships-for-suicide-prevention]

The Columbia TeenScreen Program says that it stands by its mission to provide voluntary mental health screening for young Americans and is happy to address details about the program and its success. Some frequently asked questions and their responses can be found on the CTSP website under "Setting the Record Straight," which provides fact-based information and details the voluntary nature of the Columbia TeenScreen program. [http://www.teenscreen.org/setting-the-record-straight-about-teenscreen]

upporting Organizations

The Columbia University TeenScreen Program has been endorsed by over 30 national professional health, family and advocacy organizations. [http://www.teenscreen.org/screening-endorsements/-national-organizations]

References