TeenScreen

Last updated
TeenScreen National Center
TeenScreen-225px.jpg
Formation1999
PurposeMental health screening
Headquarters New York City
Key people
Executive director, Laurie Flynn
Parent organization
Division of Child and Adolescent Psychiatry at Columbia University

The TeenScreen National Center for Mental Health Checkups at Columbia University was a national mental health and suicide risk screening initiative for middle- and high-school age adolescents. On November 15, 2012, according to its website, the program was terminated. The organization operated 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 was voluntary and offered through doctors' offices, schools, clinics, juvenile justice facilities, and other youth-serving organizations and settings. As of August 2011, the program had 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.

Contents

Screening program

Organization

The program was developed by a team of researchers at Columbia University, led by David Shaffer. [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] The questionnaire they developed is known as the Columbia Suicide Screen, which entered into use in 1999, an early version of what is now the Columbia Health Screen. [3] 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 adolescent mental health screening become common practice. [4]

The organization launched an initiative to provide voluntary mental health screening to all U.S. teens in 2003. The following year, TeenScreen was included in the national Suicide Prevention Resource Center's (SPRC) list of evidence-based suicide prevention programs. [5] 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. [6] In 2009, the organization launched the TeenScreen Primary Care initiative to increase mental health screening by pediatricians and other primary care providers, the same year the U.S. Preventive Services Task Force recommended annual adolescent mental health screening as part of routine primary care, and the Institute of Medicine recommended expansion of prevention and early identification programs. [7]

As of 2011, the program was 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. [8]

As of November 15, 2012, TeenScreen has been terminated, will no longer train or register new programs, and will cease all operations by the end of the year. [9]

Mission and locations

The mission of the TeenScreen National Center was to expand and improve the early identification of mental health problems in youth. [6] [10] In particular, TeenScreen aimed to find young people at risk of suicide or developing mental health disorders so they could 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. [10] From 2003 until 2012, the program was offered nationally [5] in schools, clinics, doctors' offices and in youth service environments such as shelters and juvenile justice settings. [6] As of August 2011, more than 2,000 primary care providers, schools and community-based sites in 46 states offered 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. [11]

Screening process

TeenScreen provided 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 provided mental health screening to adolescents. [12] A toolkit was provided, including researched and validated questionnaires, instructions for administering, scoring and interpreting the screening responses. Primary care program materials included information on primary care referrals for clinical evaluation. [12] In the school and community setting, the screening process was voluntary and required active parental consent and participant assent prior to screening sessions. [1]

The validated questionnaires included items about depression, thoughts of suicide and attempts, anxiety, and substance use. [6] The screening questionnaires typically took up to ten minutes for an adolescent to complete. [1] Once the responses to the questionnaire had been reviewed, any adolescent identified as being at possible risk for suicide or other mental health concerns would then assessed by a health or mental health professional. The result of this assessment determined whether the adolescent could be referred for mental health services. If this was the case, parents were involved and provided with help locating the appropriate mental health services. [6]

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. [13] 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. [6] 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. [12]

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. [14] 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. [15]

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. [16] 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. [16] Neither was there any greater risk for "high risk" students. [16] 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. [17]

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. [18]

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. [19] Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations. [20]

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). [7] 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. [12] 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. [21]

There is opposition to mental health screening programs in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups. [22] Much of the opposition is led by groups who claim that the organization is funded by the pharmaceutical industry; [21] however, in 2011, an inquiry launched by Senator Charles E. Grassley into the funding of health advocacy groups by pharmaceutical, medical-device, and insurance companies demonstrated to Senator Grassley's satisfaction that TeenScreen does not receive funding from the pharmaceutical industry. Sen. Grassley sent a letter to TeenScreen and 33 other organizations like the American Cancer Society asking about their financial ties to the pharmaceutical industry. TeenScreen replied saying they did not accept money from medical companies. [23]

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. [24] 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. [21]

Related Research Articles

Suicide is the second leading cause of death for people in the United States from the ages of 10 to 56.

Preventive healthcare Prevent and minimize the occurrence of diseases

Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

The New Freedom Commission on Mental Health was established by U.S. President George W. Bush through Executive Order 13263 on April 29, 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings. The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

Suicide prevention Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.

Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives intentionally.

Adolescent medicine also known as adolescent and young adult medicine is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, at which time adulthood begins. Typically, patients in this age range will be in the last years of middle school up until college graduation. In developed nations, the psychosocial period of adolescence is extended both by an earlier start, as the onset of puberty begins earlier, and a later end, as patients require more years of education or training before they reach economic independence from their parents.

The sexuality of US adolescents includes their feelings, behaviors and development, and the place adolescent sexuality has in American society, including the response of the government, educators, parents, and other interested groups.

Adolescent health, or youth health, is the range of approaches to preventing, detecting or treating young people's health and well-being.

Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and other countries are high. Youth suicide attempts are more common among girls, but adolescent males are the ones who usually carry out suicide. Suicide rates in youths have nearly tripled between the 1960s and 1980s. For example, in Australia suicide is second only to motor vehicle accidents as its leading cause of death for people aged 15–25, and according to the National Institute for Mental Health, suicide is the third leading cause of death among teens in the United States.

A depression rating scale is a psychiatric measuring instrument having descriptive words and phrases that indicate the severity of depression for a time period. When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. Several rating scales are used for this purpose.

Depression in childhood and adolescence Pediatric depressive disorders

Depression is a mental disorder characterized by prolonged unhappiness or irritability, accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement; low self-regard or worthlessness; difficulty concentrating or indecisiveness; or recurrent thoughts of death or suicide. Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults. Children who are under stress, experiencing loss, have attention, learning, behavioral, or anxiety disorders are at a higher risk for depression. Childhood depression is often comorbid with mental disorders outside of other mood disorders; most commonly anxiety disorder and conduct disorder. Depression also tends to run in families. In a 2016 Cochrane review cognitive behavior therapy (CBT), third wave CBT and interpersonal therapy demonstrated small positive benefits in the prevention of depression. Psychologists have developed different treatments to assist children and adolescents suffering from depression, though the legitimacy of the diagnosis of childhood depression as a psychiatric disorder, as well as the efficacy of various methods of assessment and treatment, remains controversial.

Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, transgender (LGBT) youth are significantly higher than among the general population.

CRAFFT Screening Test

The CRAFFT is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents. CRAFFT stands for the key words of the 6 items in the second section of the assessment - Car, Relax, Alone, Forget, Friends, Trouble. As of 2020, updated versions of the CRAFFT known as the “CRAFFT 2.1” and "CRAFFT 2.1+N" have been released.

School-based health centers (SBHCs) are primary care clinics based on primary and secondary school campuses in the United States.  Most SBHCs provide a combination of primary care, mental health care, substance abuse counseling, case management, dental health, nutrition education, health education and health promotion. An emphasis is placed on prevention and early intervention. School-based health centers generally operate as a partnership between the school district and a community health organization, such as a community health center, hospital, or the local health department. Most SBHCs report that the majority of their student population is eligible for the National School Lunch program, a common indicator of low socioeconomic status.

Mental health in education

Mental health—emotional, psychological, and social well-being—is often viewed as an adult issue, but in fact, almost half of adolescents in the United States are affected by mental disorders, and about 20% of these are categorized as “severe.” Mental health issues can pose a huge problem for students in terms of academic and social success in school. Education systems around the world treat this topic differently, both directly through official policies and indirectly through cultural views on mental health and well-being. These curriculums are in place to effectively identify mental health disorders and treat it using therapy, medication, or other tools of alleviation.

John R. Knight is an Associate Professor of Pediatrics at Harvard Medical School (HMS) and the Associate Director for Medical Education at the HMS Division on Addictions. In 1999, he founded the Center for Adolescent Substance Abuse Research (CeASAR) and its companion outpatient clinic, the Adolescent Substance Abuse Program (ASAP). CeASAR and ASAP were the first programs of their kind to be located at a children’s hospital. He is best known as the clinical scientist who developed and validated the CRAFFT substance abuse screen for adolescents. In 2008 he was named the inaugural incumbent of the Boston Children’s Hospital Endowed Chair in Developmental Medicine

The 9-question Patient Health Questionnaire (PHQ-9) is a diagnostic tool introduced in 2001 to screen adult patients in a primary care setting for the presence and severity of depression. It rates depression based on the self-administered Patient Health Questionnaire (PHQ). The PHQ is part of Pfizer's larger suite of trademarked products, called the Primary Care Evaluation of Mental Disorders (PRIME-MD). The PHQ-9 takes less than 3 minutes to complete and simply scores each of the 9 DSM-IV criteria for depression based on the mood module from the original PRIME-MD. Primary care providers frequently use the PHQ-9 to screen for depression in patients.

Stan Kutcher is a Canadian Senator and Professor Emeritus of Psychiatry at Dalhousie University. He was appointed to the Senate of Canada on December 12, 2018.

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance use screenings as a routine preventive service in healthcare.

Mental health during the COVID-19 pandemic Psychological aspect of viral outbreak

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References

  1. 1 2 3 4 Kaplan, Arline (1 March 2006). "Battling a National Killer: TeenScreen Aims To Prevent Teen Suicide". Psychiatric Times. p. 1.
  2. 1 2 Vanderwerf, Linda (7 July 2011). "County studying two new mental health initiatives". West Central Tribune.
  3. ↑ "Print Preview". Archived from the original on 2011-10-02. Retrieved 2011-08-10.
  4. ↑ 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.
  5. 1 2 "Columbia University TeenScreen Program: Science into Policy, Prevention and Action 2004 Overview" (PDF). TeenScreen.org. Columbia University. 2004. Archived from the original (PDF) on 25 April 2012. Retrieved 16 August 2011.
  6. 1 2 3 4 5 6 "TeenScreen". National Registry of Evidence-Based Programs and Practice. February 2007. Archived from the original on 2 October 2011. Retrieved 10 August 2011.
  7. 1 2 Landro, Laura (30 August 2011). "Will students take a mental health test?". The Wall Street Journal. Retrieved 6 September 2011.
  8. ↑ "Our Leadership". TeenScreen.org. Archived from the original on May 24, 2011. Retrieved 16 August 2011.
  9. ↑ "Important Announcement for Schools & Communities". TeenScreen.org. Archived from the original on 16 April 2013. Retrieved 8 February 2013.
  10. 1 2 "TeenScreen National Center Brochure" (PDF). TeenScreen.org. TeenScreen National Center. 11 March 2011. Archived from the original (PDF) on 25 April 2012. Retrieved 6 September 2011.
  11. ↑ "Local Programs". TeenScreen.org. Archived from the original on 15 April 2013. Retrieved 16 August 2011.
  12. 1 2 3 4 Allen, Patricia L.; McGuire, Leslie (2011). "Incorporating mental health checkups into adolescent primary care visits". Pediatric Nursing. 37 (3): 137–41. PMID   21739747.
  13. ↑ "The Surgeon General's Call To Action To Prevent Suicide, 1999". U.S. Surgeon General. 1999. Retrieved 12 August 2011.
  14. ↑ "Screening for Suicide Risk: A Systematic Evidence Review for the U.S. Preventive Services Task Force" (PDF). AHRQ.gov. May 2004. Retrieved 10 August 2011.
  15. ↑ Williams, SB; O'Connor, E; Eder, M; Whitlock, E (2009). PMID   20722167.{{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  16. 1 2 3 Gould MS, Marrocco FA, Kleinman M, et al. (April 2005). "Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial". JAMA. 293 (13): 1635–43. doi: 10.1001/jama.293.13.1635 . PMID   15811983.
  17. ↑ 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.
  18. ↑ 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. PMID   21871370.
  19. ↑ 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. 48 (1): 71–8. doi:10.1007/s10597-011-9413-x. PMID   21559920. S2CID   19912746.
  20. ↑ 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. S2CID   9993850.
  21. 1 2 3 Franck, Matthew (13 December 2005). "Screenings prompt fears of false labels". St. Louis Post-Dispatch. p. A1.
  22. ↑ Dejka, Joe (16 September 2008). "Can test save lives?". Omaha World-Herald. p. 1A.
  23. ↑ Perry, Suzanne (11 May 2011). "Senator Prods Medical Non-profits to Disclose More About Industry Contributions". The Chronicle of Philanthropy. Retrieved 13 September 2011.
  24. ↑ Lenzer, Jeanne (2005). "US teenager's parents sue school over depression screening test". British Medical Journal. Retrieved 2 August 2011.
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