TeenScreen

TeenScreen National Center
Formation	1999
Purpose/focus	Mental health screening
Headquarters	New York City
Key people	Executive director, Laurie Flynn Deputy executive director, Leslie McGuire
Parent organization	Division of Child and Adolescent Psychiatry at Columbia University
Website	teenscreen.org

The TeenScreen National Center for Mental Health Checkups at Columbia University is an evidence-based, national mental health and suicide risk screening initiative for middle- and high-school age adolescents. The organization operates as a center in the Division of Child and Adolescent Psychiatry Department at Columbia University, in New York City. The program was developed at Columbia University in 1999, and launched nationally in 2003. Screening is voluntary and offered through doctors' offices, schools, clinics, juvenile justice facilities, and other youth-serving organizations and settings. As of August 2011^[update], the program has more than 2,000 active screening sites across 46 states in the United States, and in other countries including Australia, Brazil, India and New Zealand.

Screening program

Organization

The TeenScreen program was developed by a team of researchers at Columbia University, led by the director of the university's Division of Child and Adolescent Psychiatry, David Shaffer, M.D.^[1] The goal was to make researched and validated screening questionnaires available for voluntary identification of possible mental disorders and suicide risk in middle and high school students.^[2] These questionnaires include the Columbia Suicide Screen that was researched and developed at Columbia University.^[1] Schools and communities using the TeenScreen program began screening adolescents in 1999.^[1] In 2003, the New Freedom Commission on Mental Health, created under the administration of George W. Bush, identified the TeenScreen program as a "model" program^[1] and recommended that adolescent mental health screening become common practice in the early identification and assessment of mental health disorders in youth.^[3]

The organization launched a national initiative to offer voluntary mental health screening to all U.S. teens in 2003. The following year, TeenScreen was approved for inclusion in the national Suicide Prevention Resource Center's (SPRC) list of evidence-based suicide prevention programs.^[4] In 2007, it was 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 as a scientifically tested and reviewed intervention.^[5] In 2009, the organization launched TeenScreen Primary Care to increase mental health screening by pediatricians and other primary care providers. The launch of the initiative coincided with increasing support for adolescent mental health screening from health and medical organizations. In the same year the U.S. Preventive Services Task Force recommended that annual adolescent mental health screening be incorporated into routine primary care and the Institute of Medicine recommended expansion of prevention and early identification programs.^[6]

As of 2011^[update], the program is led by executive director Laurie Flynn, deputy executive director Leslie McGuire and scientific advisor Mark Olfson, M.D., alongside a National Advisory Council of healthcare professionals, educators and advocates.^[7]

Mission and locations

The mission of the TeenScreen National Center is to expand and improve the early identification of mental health problems in youth.^[8][5] In particular, TeenScreen aims to find young people at risk of suicide or developing mental health disorders so that they can be referred for a comprehensive mental health evaluation by a health professional.^[2] The program focuses on providing screening to young people in the 11-18 age range.^[8] Since 2003, the program has been offered nationally^[4] in schools, clinics, doctors' offices and in youth service environments such as shelters and juvenile justice settings.^[5] As of August 2011^[update], more than 2,000 primary care providers, schools and community-based sites in 46 states offer adolescent mental health screening through the TeenScreen National Center. In addition, the screening was also being provided in other countries including Australia, Brazil, India, New Zealand and Scotland.^[9]

Screening process

TeenScreen provides materials, training and technical help through its TeenScreen Primary Care and Schools and Communities programs for primary care providers, schools and youth-serving organizations that want to offer mental health screening to adolescents.^[10] A toolkit is provided, including researched and validated questionnaires, instructions for administering, scoring and interpreting the screening responses. Primary care program materials include information on primary care referrals for clinical evaluation.^[10] In the school and community setting, the screening process is voluntary and requires active parental consent and participant assent prior to the screening session.^[1]

The validated questionnaires include items about depression, thoughts of suicide and attempts, anxiety, and substance use.^[5] The screening questionnaires typically take up to 10 minutes for an adolescent to complete.^[1] Once the responses to the questionnaire have been reviewed, any adolescent identified as being at possible risk for suicide or other mental health concerns is then assessed by a health or mental health professional. The result of this assessment determines whether the adolescent should be referred for mental health services. If this is the case, parents are involved and provided with help locating the appropriate mental health services.^[5]

Research, endorsements and responses

Recommendations and research

Mental health screening has been endorsed by the former U.S. Surgeon General David Satcher, who launched a "Call to Action" in 1999 encouraging the development and implementation of safe, effective school-based programs offering intervention, help and support to young people with mental health issues.^[11] TeenScreen 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 as a scientifically tested and reviewed intervention.^[5] In addition, the U.S. Preventive Services Task Force recommended in 2009 that mental health screening for teenagers be integrated into routine primary care appointments.^[10]

Studies have been conducted on the effectiveness and impact of mental health screening for young people. In a 2004 systematic evidence review, the U.S. Preventive Services Task Force found that there were no studies that addressed whether screening as part of primary care reduced morbidity and mortality, nor any information of the potential risks of screening.^[12] In a later review, published in 2009, the task force found that there was evidence supporting the efficacy of screening tools in identifying teenagers at risk of suicide or mental health disorders.^[13]

A team of researchers from Columbia University and the New York State Psychiatric Institute completed a randomized controlled clinical trial on the impact of suicide screening on high school students in New York State from 2002-2004.^[14] The study found that students who were given a questionnaire about suicide were no more likely to report suicidal thoughts after the survey than students in the control group who had not been questioned.^[14] Neither was there any greater risk for "high risk" students.^[14] A subsequent study by the researchers, in 2009, found that screening appeared to increase the likelihood that adolescents would receive treatment if they were at risk for mental health disorders or suicide.^[15]

A study published in 2011, involving 2,500 high school students, examined the value of routine mental health screening in school to identify adolescents at-risk for mental illness, and to connect those adolescents with recommended follow-up care. The research, conducted between 2005 and 2009 at six public high schools in suburban Wisconsin, found that nearly three out of four high school students identified as being at-risk for having a mental health problem were not in treatment at the time of screening. Of those students identified as at-risk, a significant majority (76.3 percent) completed at least one visit with a mental health provider within 90 days of screening. More than half (56.3 percent) received minimally adequate treatment, defined as having three or more visits with a provider, or any number of visits if termination was agreed to by the provider.^[16]

A separate study published in 2011, found that mental health screening was effective at connecting African-American middle school students from a predominantly low-income area with school-based mental health services.^[17] Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations.^[18]

Acceptance and critical responses

Recommendations endorsing adolescent mental health screening have been issued by the Institute of Medicine (IOM) and the U.S. Preventative Services Task Force (USPSTF).^[6] The American Academy of Pediatrics recommends assessment of mental health at primary care visits and suggests the use of validating screening instruments. These add to statements and recommendations to screen adolescents for mental illness from the American Medical Association (AMA), the Society for Adolescent Health and Medicine, the American Academy of Family Physicians and the National Association of Pediatric Nurse Practitioners.^[10] TeenScreen has been endorsed by a number of organizations, including the National Alliance for the Mentally Ill, and federal and state commissions such as the New Freedom Commission.^[19]

There is opposition to mental health screening programs in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups.^[20] Rep. Ron Paul has opposed screening programs such as TeenScreen on the grounds that they negate parental rights, are not supported by evidence that suicide attempts are reduced and also may lead to overmedication of young people.^[1] The TeenScreen National Center has also been opposed by groups who claim that the organization is funded by the pharmaceutical industry.^[19] In 2011, Senator Charles E. Grassley launched an inquiry into the funding of health advocacy groups by pharmaceutical, medical-device, and insurance companies. The TeenScreen National Center was questioned in the first stage of the inquiry but was not included in the second round as it had demonstrated to Senator Grassley's satisfaction that it does not receive funding from the pharmaceutical industry.^[21]

In 2005, TeenScreen was criticized following media coverage of a suit filed a local screening program in Indiana by the parents of a teenager who had taken part in screening. The suit alleged that the screening had taken place without parents' permissions.^[22] The complaint led to a change in how parental consent was handled by TeenScreen sites. In 2006, the program's policy was amended so that active rather than passive consent was required from parents before screening adolescents in a school setting.^[19]

References

1. ^ ^{a b c d e f g} Kaplan, Arline (1 March 2006). "Battling a National Killer: TeenScreen Aims To Prevent Teen Suicide". Psychiatric Times: p. 1. 
2. ^ ^{a b} Vanderwerf, Linda (7 July 2011). "County studying two new mental health initiatives". West Central Tribune. 
3. ^ 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.
4. ^ ^{a b} "Columbia University TeenScreen Program: Science into Policy, Prevention and Action 2004 Overview". TeenScreen.org. Columbia University. 2004. http://www.teenscreen.org/images/stories/PDF/2004%20Annual%20Overview.pdf. Retrieved 16 August 2011. 
5. ^ ^{a b c d e f} "TeenScreen". National Registry of Evidence-Based Programs and Practice. February 2007. http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=150. Retrieved 10 August 2011. 
6. ^ ^{a b} Landro, Laura (30 August 2011). "Will students take a mental health test?". The Wall Street Journal. http://online.wsj.com/article/SB10001424053111904199404576538292146976766.html. Retrieved 6 September 2011. 
7. ^ "Our Leadership". TeenScreen.org. http://www.teenscreen.org/about/our-leadership/. Retrieved 16 August 2011. 
8. ^ ^{a b} "TeenScreen National Center Brochure" (PDF). TeenScreen.org. TeenScreen National Center. 11 March 2011. http://www.teenscreen.org/images/stories/PDF/NatCenterBrochure3.11.11.pdf. Retrieved 6 September 2011. 
9. ^ "Local Programs". TeenScreen.org. http://www.teenscreen.org/programs/local-programs/. Retrieved 16 August 2011. 
10. ^ ^{a b c d} Allen, Patricia L.; McGuire, Leslie (2011). "Incorporating mental health checkups into adolescent primary care visits". Pediatric Nursing 37 (3): 137–41. 
11. ^ "The Surgeon General's Call To Action To Prevent Suicide, 1999". U.S. Surgeon General. 1999. http://www.surgeongeneral.gov/library/calltoaction/recommendations.htm. Retrieved 12 August 2011. 
12. ^ "Screening for Suicide Risk: A Systematic Evidence Review for the U.S. Preventive Services Task Force". AHRQ.gov. May 2004. http://www.ahrq.gov/downloads/pub/prevent/pdfser/suicidser.pdf. Retrieved 10 August 2011. 
13. ^ Williams, SB; O'Connor, E; Eder, M; Whitlock, E (2009). PMID 20722167. 
14. ^ ^{a b c} 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
15. ^ Gould, MS; Marrocco, FA; Hoagwood, K; Kleinman, M; Amakawa, L; Altschuler, E (2009). "Service use by at-risk youths after school-based suicide screening". Journal of the American Academy of Child and Adolescent Psychiatry 48 (12): 1193–201. doi:10.1097/CHI.0b013e3181bef6d5. PMC 2891889. PMID 19858758. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2891889. 
16. ^ Husky, Mathilde M.; Sheridan, Marian; McGuire, Leslie; Olfson, Mark (2011). "Mental Health Screening and Follow-up Care in Public High Schools". Journal of the American Academy of Child & Adolescent Psychiatry 50 (9): 881–91. doi:10.1016/j.jaac.2011.05.013. 
17. ^ Husky, MM; Kanter, DA; McGuire, L; Olfson, M (2011). "Mental Health Screening of African American Adolescents and Facilitated Access to Care". Community mental health journal. doi:10.1007/s10597-011-9413-x. PMID 21559920. 
18. ^ Husky, MM; Miller, K; McGuire, L; Flynn, L; Olfson, M (2011). "Mental health screening of adolescents in pediatric practice". The journal of behavioral health services & research 38 (2): 159–69. doi:10.1007/s11414-009-9207-x. PMID 20127189. 
19. ^ ^{a b c} Franck, Matthew (13 December 2005). "Screenings prompt fears of false labels". St. Louis Post-Dispatch: p. A1. 
20. ^ Dejka, Joe (16 September 2008). "Can test save lives?". Omaha World-Herald: p. 1A. 
21. ^ Perry, Suzanne (11 May 2011). "Senator Prods Medical Non-profits to Disclose More About Industry Contributions". The Chronicle of Philanthropy. http://philanthropy.com/blogs/government-and-politics/senator-prods-medical-nonprofits-to-disclose-more-about-industry-contributions/28477. Retrieved 13 September 2011. 
22. ^ Lenzer, Jeanne (2005). "US teenager’s parents sue school over depression screening test". British Medical Journal. http://www.bmj.com/content/331/7519/714.2/suppl/DC1. Retrieved 2 August 2011. 

External links

• TeenScreen official website
• National Registry of Evidence Based Programs and Practice