FOR IMMEDIATE RELEASE:
Oct. 25, 2010

Two-Step Screening Process Promotes Accuracy By Minimizing Over-Identification

NEW YORK – High school students in need of mental health services are more likely to get them if they participate in proactive school screening versus the traditional school referral process, according to a new study from researchers at Columbia University Medical Center and the New York State Psychiatric Institute. Results are published in a recent issue of the Journal of Adolescence.

The study compared the traditional school referral process, which relies on the identification of potentially at-risk students by teachers, parents or the students themselves, with systematic screening using a brief mental health questionnaire provided by the Columbia University TeenScreen Schools and Communities program. Results showed that screening was more effective at identifying at-risk youth, providing referrals to mental health services, and prompting greater access of those services.

“These findings show that proactive screening with a short self-completion questionnaire is a highly effective way to identify high school students at-risk for depression or another emotional health problem, and refer them for needed assessment and treatment,” said Mathilde Husky, Ph.D., assistant professor of clinical psychology at Columbia University Medical Center and the New York State Psychiatric Institute, and first author of the paper.

Conducted in an urban school district with four high schools in Western Pennsylvania, 656 ninth-grade students were randomized to either a screening group or a control group.

Students in the screening group were asked to complete the Columbia Health Screen (CHS), a 14-item self-report questionnaire, which assesses mental health problems across six domains: depression, anxiety, irritability, social withdrawal, substance use and suicidality. After the screening, all students received a two-to-five minute debriefing – an opportunity for the students to add context to their answers or provide additional information. Next, students who scored positive on the CHS were given a clinical interview by a trained clinician at the school. If the clinician determined that further intervention was appropriate, they would refer the student to a mental health professional.

In the control group, students had access to the existing in-school referral mechanisms, including intervention plans and information about community-based mental health services – typically run through a school assistance program (SAP). A SAP typically includes the school principal, a mental health professional, guidance counselor, teacher, school nurse, and school-based probation officer.

Of the 365 students in the screening group, 103 students showed positive results on the screen. Through the post-screen debriefing, 27 were determined to not be in need of a clinical interview, and 76 were given a structured clinical interview.

“Columbia TeenScreen program’s two-stage process was important to correct the over-identification in the self-report screening – in this case, it reduced the number of students who would have been referred for additional services by 30 percent,” said Dr. Husky.

Of the 76 students in the screening group given a clinical interview, 71 students were deemed to be in need of further evaluation and possible treatment, and were referred to appropriate mental health services (the remaining five did not participate beyond the clinical interviews).

In comparison, of the 291 students in the control group, only three were referred by traditional observation methods for assessment and possible treatment.

High School Offers an Important Window for Mental Health Intervention

Adolescence is an important window for intervention because 50 percent of all lifetime mental health disorders start by age 14, according to the National Institute of Mental Health. And because evidence has demonstrated that symptoms of mental illness typically occur two to four years before the onset of a full-blown disorder, adolescence is often an ideal period for early intervention to reduce the long-term severity of illness. Untreated depression or other mental health problems can lead to school failure, drug and alcohol abuse, violence, criminal involvement, and other issues that may delay the life/social experiences (e.g., school achievement, future/career-planning, dating, increased independence, etc.) that define an adolescent’s critical developmental years. And most tragically, untreated mental illness can lead to suicide – the third leading cause of death among adolescents.

Because many mental health problems are difficult to detect, particularly in the adolescent years, mental health checkups are especially valuable. Each year more than 500,000 teens make a suicide attempt serious enough to require medical attention. According to the National Institute of Mental Health of the National Institutes of Health, more than 90 percent of suicide victims suffer from mental illness at the time of their death. Most of these teens are not in treatment at the time of their deaths.

The TeenScreen National Center for Mental Health Checkups at Columbia University is a non-profit public health initiative and national policy and resource center devoted to increasing youth access to regular mental health checkups. The TeenScreen National Center is affiliated with the Columbia University Division of Child and Adolescent Psychiatry. The National Center provides free tools for physicians and school professionals and supports screening efforts in 45 states and more than 1,285 communities through its TeenScreen Primary Care and TeenScreen Schools and Communities programs. www.teenscreen.org.

The TeenScreen program grew out of research conducted by Columbia in the 1990s, which found that screening is effective in accurately identifying signs of possible mental illness and risk of suicide in youth. TeenScreen was first implemented as a nationwide screening program in schools and communities. In 2009, when new expert guidelines recommended routine screening as part of medical care, the program expanded into primary care settings. The center is funded by private foundations, individuals, and organizations committed to the early identification of mental illness in youth and the prevention of teen suicide.

For information about teen depression and suicide, visit http://www.teenscreen.org/about/adolescent-depression-suicide and http://www.teenscreen.org/images/stories/PDF/YouthSuicideandPrevention.pdf.

For facts and figures about adolescent mental health and suicide in Pennsylvania, visit http://www.teenscreen.org/states/pennsylvania-adolescent-mental-health-fact-sheet/.

For more information about TeenScreen Schools and Communities, visit:
http://www.teenscreen.org/programs/schools-communities/.

For more information about TeenScreen Primary Care, visit: http://www.teenscreen.org/programs/primary-care/.

For more information:
Elizabeth Streich
streich@childpsych.columbia.edu
212-265-3174