TeenScreen
Encyclopedia
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. , 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
.
, led by the director of the university's Division of Child and Adolescent Psychiatry, David Shaffer, M.D. 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. These questionnaires include the Columbia Suicide Screen that was researched and developed at Columbia University. Schools and communities using the TeenScreen program began screening adolescents in 1999. 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 and recommended that adolescent mental health screening become common practice in the early identification and assessment of mental health disorders in youth.
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. 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. 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.
, 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.
, Brazil
, India
, New Zealand
and Scotland
.
The validated questionnaires include items about depression, thoughts of suicide and attempts, anxiety, and substance use. The screening questionnaires typically take up to 10 minutes for an adolescent to complete. 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.
, 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. 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. 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.
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. 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.
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. 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. Neither was there any greater risk for "high risk" students. 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.
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.
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. Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations.
There is opposition to mental health screening programs in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups. 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. The TeenScreen National Center has also been opposed by groups who claim that the organization is funded by the pharmaceutical industry. 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.
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. 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.
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
and suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
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
Columbia University
Columbia University in the City of New York is a private, Ivy League university in Manhattan, New York City. Columbia is the oldest institution of higher learning in the state of New York, the fifth oldest in the United States, and one of the country's nine Colonial Colleges founded before the...
, in New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...
. 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. , the program has more than 2,000 active screening sites across 46 states in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, and in other countries including Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
, India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
and New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
.
Organization
The TeenScreen program was developed by a team of researchers at Columbia UniversityColumbia University
Columbia University in the City of New York is a private, Ivy League university in Manhattan, New York City. Columbia is the oldest institution of higher learning in the state of New York, the fifth oldest in the United States, and one of the country's nine Colonial Colleges founded before the...
, led by the director of the university's Division of Child and Adolescent Psychiatry, David Shaffer, M.D. 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. These questionnaires include the Columbia Suicide Screen that was researched and developed at Columbia University. Schools and communities using the TeenScreen program began screening adolescents in 1999. In 2003, the New Freedom Commission on Mental Health
New Freedom Commission on Mental Health
The controversial New Freedom Commission on Mental Health was established by U.S. President George W. Bush in April 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings...
, created under the administration of George W. Bush
George W. Bush
George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....
, identified the TeenScreen program as a "model" program and recommended that adolescent mental health screening become common practice in the early identification and assessment of mental health disorders in youth.
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
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
suicide prevention programs. In 2007, it was included as an evidence-based program in the U.S. Substance Abuse and Mental Health Services Administration
Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration is a branch of the U.S. Department of Health and Human Services. It is charged with improving the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to...
(SAMHSA)'s National Registry of Evidence-based Programs and Practices as a scientifically tested and reviewed intervention. 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
Institute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
recommended expansion of prevention and early identification programs.
, 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.
Mission and locations
The mission of the TeenScreen National Center is to expand and improve the early identification of mental health problems in youth. 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. The program focuses on providing screening to young people in the 11-18 age range. Since 2003, the program has been offered nationally in schools, clinics, doctors' offices and in youth service environments such as shelters and juvenile justice settings. , 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 AustraliaAustralia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
, India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
, New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
and Scotland
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
.
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. 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. In the school and community setting, the screening process is voluntary and requires active parental consent and participant assent prior to the screening session.The validated questionnaires include items about depression, thoughts of suicide and attempts, anxiety, and substance use. The screening questionnaires typically take up to 10 minutes for an adolescent to complete. 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.
Recommendations and research
Mental health screening has been endorsed by the former U.S. Surgeon General David SatcherDavid Satcher
David Satcher, M.D., Ph.D. FAAFP, FACPM, FACP is an American physician, and public health administrator. He was a four-star admiral in the United States Public Health Service Commissioned Corps and served as the 10th Assistant Secretary for Health, and the 16th Surgeon General of the United...
, 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. TeenScreen is included as an evidence-based program in the U.S. Substance Abuse and Mental Health Services Administration
Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration is a branch of the U.S. Department of Health and Human Services. It is charged with improving the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to...
(SAMHSA)'s National Registry of Evidence-based Programs and Practices as a scientifically tested and reviewed intervention. 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.
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. 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.
A team of researchers from Columbia University and the New York State Psychiatric Institute
New York State Psychiatric Institute
The New York State Psychiatric Institute, established in 1895 and located on Riverside Drive at the foot of Washington Heights, the far upper west side of Manhattan in New York City, was one of the first institutions in the United States to integrate teaching, research and therapeutic approaches to...
completed a randomized controlled clinical trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
on the impact of suicide screening on high school students in New York State from 2002-2004. 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. Neither was there any greater risk for "high risk" students. 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.
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.
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. Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations.
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). 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. 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.There is opposition to mental health screening programs in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups. Rep. Ron Paul
Ron Paul
Ronald Ernest "Ron" Paul is an American physician, author and United States Congressman who is seeking to be the Republican Party candidate in the 2012 presidential election. Paul represents Texas's 14th congressional district, which covers an area south and southwest of Houston that includes...
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. The TeenScreen National Center has also been opposed by groups who claim that the organization is funded by the pharmaceutical industry. 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.
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. 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.