Test Takes on
Teens' Mental Health
Rita Giordano, Philadelphia
Inquirer, February 9, 2006
For more articles like this
Somewhere in junior high, Jennifer
Rashti lost her smile.
The once-genial Cherry Hill girl began to feel sad, angry, low.
By last year, when she was a high school sophomore, Rashti was
making excuses not to go out with friends.
Then Cherry Hill High School West, which Rashti attends,
announced last winter that it was introducing TeenScreen, a
voluntary questionnaire developed by Columbia University to help
identify youngsters with undiagnosed mental health problems and
used at 44 sites in Pennsylvania and New Jersey. Rashti told her
mother that she wanted to take it.
The results pointed to depression.
"I feel much better now," said Rashti, 17, who was given a list
of counseling resources and sought therapy and medication. "I
knew I wanted help. I just wanted to show my parents that I
really needed help."
To proponents of TeenScreen, which Cherry Hill West will offer
again tomorrow, stories such as Rashti's are proof of the
Last year, about 55,000 young people took the test, which is
administered in more than 460 schools and youth programs in 42
states. Cherry Hill High School East will offer it next month.
Through 14 to 52 self-administered questions, adolescents who
suffer in silence, and may be at risk for suicide, are referred
to help if they want it.
President Bush's New Freedom Commission on Mental Health held up
TeenScreen as a model program in 2003. Yet it is cause for alarm
among a vocal group of critics who stretch from the far right to
the far left.
In campaigns often conducted via the Internet, detractors
including the Church of Scientology and self-described survivors
of the psychiatric system accuse TeenScreen of undermining
parental authority, violating privacy, putting potentially
harmful ideas in children's heads, stigmatizing children, being
a tool for the pharmaceutical industry, and potentially steering
youths toward medication that may be unsafe for them. Some say
mental health screening doesn't belong in schools.
Ken Kramer, a Florida man whose Web site PsychSearch.net
documents alleged psychiatric abuse, has declared war on
TeenScreen. He rejects disclaimers by the testing organization
that it neither noses children nor prescribes them drugs.
"They're not the hangman. They're the gallows-builders. They
lead them to the drugs," said Kramer, whose Scientology religion
Vera Hassner Sharav, president of the Alliance for Human
Research Protection, which seeks to protect the rights of
participants in medical research, called TeenScreen a "flawed
Critics like Sharav cite Columbia's own research to argue that
TeenScreen has a high rate of false-positive results. David
Shaffer, a Columbia professor who developed TeenScreen, denied
the assertion. He said most children who tested positive in the
study pointed to by opponents had a psychiatric problem even if
they were not suicidal.
Leslie McGuire, director of Columbia's three-year-old program,
did not anticipate the vehemence of the test's critics.
"It definitely took me by surprise," McGuire said. "This
honestly is a program that purely has good intentions."
Youths who take TeenScreen, on paper or online, answer one of
three confidential surveys designed to identify signs of
depression, suicidal thoughts, or a range of emotional problems.
An on-site mental health worker reviews responses and asks
follow-up questions if needed.
If further evaluation is suggested, the student or family is
given a list of care providers, some of whom charge reduced
rates. TeenScreen urges schools to notify parents within 24
hours. (Other organizations may give youths the option not to
involve parents.) Subsequent treatment, if sought, is
independent of TeenScreen and the testing site.
TeenScreen cites findings by the U.S. surgeon general that 90
percent of teens who commit suicide had a mental disorder, and
that most mentally ill youths do not get treatment. And research
published in the Journal of the American Medical Association,
they say, disputes the notion that screening leads to more
Youth suicides have fallen in recent years, and their number is
not huge. The Centers for Disease Control and Prevention,
however, lists suicide as the third leading cause of death among
12- to 19-year-olds nationally and in Pennsylvania. In New
Jersey, it is the fourth-leading cause.
"This is a major health problem that is invisible until it hits
close to home," said Michael Hogan, Ohio's mental health
director, who chaired the New Freedom Commission.
Hogan called TeenScreen critics "a curious coalition" with whom
he disagrees, but who have understandable concerns about
pharmaceutical companies and the safety of drugs for children.
TeenScreen officials deny critics' suggestions that they take
drug company money. An exception, they acknowledge, was a $7,500
grant from Eli Lilly & Co., manufacturer of Prozac, to buy
computers about six years ago.
Columbia does not identify groups that administer its survey,
citing confidentiality concerns. There are six test sites in New
Jersey and 38 in Pennsylvania, including the Family Service
Association of Bucks County's Teen Center and Girls and Boys
Town of Philadelphia, a residential girls' juvenile justice
facility. Both say they are pleased with TeenScreen.
Joseph Rogers, president of the Mental Health Association of
Southeastern Pennsylvania, has reservations about mass
screenings. He doesn't trust schools not to stigmatize kids, he
said, and care is already insufficient to meet demand. He would
rather see more public money go to mental health treatment, he
"We're going to screen these kids, slap a label on them, and
then what?" Rogers said.
TeenScreen opponents have also made much of the fact that some
test administrators have not sought active parental consent:
Children were given the test unless their parents objected.
The conservative Rutherford Institute has filed a federal
lawsuit on behalf of an Indiana family who say their daughter
was tested at school without their knowledge.
Teresa Rhoades of Osceola, Ind., said daughter Chelsea, 15, was
told that her answers indicated that she could have
obsessive-compulsive disorder and social anxiety. The reason,
said Rhoades, was that Chelsea revealed she often helped clean
the house and did not go out a lot.
"Both my husband and I told her, 'Honey, those aren't
conditions.' Those are the way she was raised," Rhoades said.
The school district, named in the lawsuit with a local mental
health provider, will seek explicit parental consent this year,
but participation in TeenScreen has fallen dramatically, a
district spokeswoman said. Only 35 of about 830 10th graders are
In Cherry Hill, which has experienced a number of teen suicides
in the last several years, 68 sophomores out of about 960 in
both schools took the test in 2005. Ten were referred for
"Did we save 10 kids? In my mind, yes," said Jennifer DiStefano,
the district student assistance coordinator.
At Cherry Hill West, where all 1,600 students are eligible to
take the test tomorrow, 27 were signed up. The national norm for
participation is 33 percent to 50 percent, TeenScreen's McGuire
"People always want to think, 'It's not my kid,' that 'nothing
like this could affect my family,' " said Maggie Suender,
president of the Cherry Hill West PTA, whose two sons will take
Some Cherry Hill parents interviewed said their children would
not take TeenScreen because they didn't need it. Professionals
such as DiStefano say it can be hard to tell.
"I can't imagine the majority of my 11,000 students telling
their parents everything," she said.
Not only does TeenScreen flag kids whose symptoms are hidden, it
gets them help faster than if they sought it on their own,
DiStefano said. Many mental health professionals on the list
Cherry Hill provides give TeenScreen referrals priority and,
often, a reduced rate.
"To me, this is so positive," DiStefano said.
Linda Rashti said it had taken a few months to get Jennifer a
therapist they both liked and who would accept the family's
insurance. Rashti is glad for the program, however.
"I didn't know how negative Jen felt," she said. "You can't
Jennifer Rashti, a swimmer and a good student, said she wanted
to tell other young people to seek help, "that suicide isn't the
only way out, that it's the worst thing."
After making excuses not to go out, she said, she likes being
with people again. She doesn't feel so shy anymore, or so angry.
"I still get depressed sometimes, but not as bad," she said.
"I'm actually enjoying life."
Mental Health Hotlines
For someone to talk to, visit
www.suicidehotlines.com/ or call
one of these numbers. All are 24 hours unless noted.
National: 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK
Sample TeenScreen Questions
TeenScreen results, designed to flag the likelihood of a mental
health disorder, are given immediate on-site assessment. If
further questions suggest the need for professional evaluation,
a list of clinicians is provided. The decision to make an
appointment is optional and private.
• During the last three months, how much of a problem have you
had with feeling nervous or afraid? (Response options: no
problem, slight problem, medium problem, bad problem, very bad
• Have you felt like nothing is fun for you and you just aren't
interested in anything?
• Has there been a time when you felt you couldn't do anything
well or that you weren't as good-looking or smart as other
• Have you often felt grouchy or irritable and often in a bad
mood, when even little things would make you mad?
• Have you thought seriously about killing yourself?
SOURCE: Columbia University TeenScreen Program
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