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Article of Interest - Mental Health

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Test Takes on Teens' Mental Health
Rita Giordano, Philadelphia Inquirer, February 9, 2006
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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 survey's merit.

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 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 bars psychotherapy.

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 instrument."

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 suicidal thoughts.

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 said.

"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 signed up.

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 assessment.

"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 said.

"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 the test.

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 always tell."

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 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 (1-800-273-8255).

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 problem.)

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 people?

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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