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Columbia University TeenScreen  Program. The Carmel Hill Center at the Division of Child & Adolescent Psychiatry Columbia University. Presentation Overview. What is the Columbia TeenScreen Program? The problems of undiagnosed mental illness and suicide in youth

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Columbia UniversityTeenScreen Program

The Carmel Hill Center at the Division of Child & Adolescent Psychiatry Columbia University


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Presentation Overview

  • What is the Columbia TeenScreen Program?

  • The problems of undiagnosed mental illness and suicide in youth

  • Support for mental health screening

  • How the TeenScreen Program works

  • NAMI Maine: A Case Study

  • How to become a TeenScreen site and support

    local screening efforts


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What is the TeenScreen Program ?

  • National mental health screening program focused on:

    • Early identification of mental illness

    • Suicide prevention in youth

    • Linking those in need with further assessment

  • Goal: Provide all parents the opportunity for their teens to receive a voluntary mental health check-up

  • TeenScreen does not involve diagnosis or treatment

  • Community-based partnerships to develop screening

  • programs across the U.S.

  • Funded by private foundations, individuals and organizations


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MentalIllness in Youth

10% of US children and adolescents suffer from a serious mental disorder that causes significant functional impairment at home, at school and with peers

Twenty-one percent of US children ages 9 to 17 have a diagnosable mental or addictive disorder that causes at least minimal impairment

In any given year, only 20% of children with mental disorders are identified and receive mental health services

Half of all mood, anxiety, impulse-control and substance-use disorders start by age 14

Mental Health: A Report of the Surgeon General (1999) Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda (2000)Kessler et al., 2005


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Prevalence of Mental DisordersU.S. Children and Adolescents

Ages 9-17

14

13%

12

10

10.3%

8

6

6.2%

4

2

2%

0

Anxiety

Disorders

Disruptive

Mood

Disorders

Substance Use

Behavior

Disorders

Disorders

Shaffer et al., 1996


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Mental Health and Academic Achievement

  • 50% of children with serious emotional and behavioral disorders drop out of high school, compared to 30% of students with other disabilities (US Dept. of Education, 2001)

  • Students with mental illness have the highest drop out rate of any disability group (U.S. Dept. of Education, 2001)

  • Over half of the adolescents in the United States who fail to complete their secondary education have a diagnosable psychiatric disorder (Stoep et al., 2003)


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Links Between AchievementMental Illness and Suicide

  • 90% of teens who die by suicide suffer from a treatable mental illness at their time of death

  • Psychiatric symptoms developed more than a year prior to death in 63% of completed teen suicides

  • In only 4% of cases, psychiatric symptoms developed within the 3 months immediately prior to the suicide

  • Suicide is not the unpredictable event we once thought it was

Shaffer et al. 1996


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Risk Factors for Suicide Achievement

MALE FEMALE

Depression 50% 69%

Antisocial 43% 24%

Substance Abuse 38% 17%

Anxiety 19% 48%

Previous Attempts 28% 50%

Girls attempt at much higher rates than boys (4:1)

Boys die by suicide at much higher rates than girls (4:1)

Risk factors for completed suicide:

  • 18- to 19-year olds* 60–67% 13%

  • 17- to 19-Year-olds 66% NA

Brent et al., 1999; Shaffer et al., 1996


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Secrecy: AchievementDisinhibition And Teen Suicidality

Based on multiple published studies of teens and parents:

  • 85% do not reveal ideation

  • 30%–60% do not reveal past attempt to anyone

  • 90% of attempts unknown to parents

Harkavy & Friedman 1987; Patton et al. 1997; Shaffer et al. (in preparation); Velez & Cohen 1988; Young & Zimmerman 1998


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— U N I T E D S T A T E S, A G E S 15–19, 1964–2004 —

TEEN SUICIDE RATES

Rate per100,000

Year

CDC 2006 (WISQARS) (reviewed 12/18/2006), Vital Statistics U.S. 1962–1978

E11


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Support for Mental 1964–2004 —

Health Screening


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Conditions That Are Routinely 1964–2004 —Screened for In Youth

PKU: affects less than 1% of children

Lead Poisoning: affects 2% of children

Scoliosis: affects less than 1% of children

Hearing Problems: 1-2% of children have moderate to severe hearing loss

Vision Problems: affects 15% of children

American Academy of Family Physicians 1999; CDC 2003;

National Center for Health Statistics, U.S. Department of Health and Human Services 2000;

Windeler J. & Kobberling J., 1987


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Why Should We Screen for Mental Illness and Suicide Risk? 1964–2004 —

  • Reliable screening tools that effectively identify at-risk teens

    are available

  • Mental illness is treatable

  • Most mentally ill and suicidal youth aren’t already being helped

  • There is ample time to intervene before a teen dies by suicide

  • No one else is asking teens these questions, but they will give us the answers


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Mental Health Screening and 1964–2004 —The TeenScreen Program Are Effective

  • Screening in Mid-Adolescence Identifies:

  • Teens at risk for suicide

  • Teens who are depressed or suffering from other psychiatric disorders

  • Symptomatic teens who are not already in treatment or known by school personnel

  • At-risk teens who will make improvements in their academic functioning if referred for services post screening


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Widespread Support for 1964–2004 —Screening and TeenScreen

  • President Bush’s New Freedom Commission on Mental Health

  • Garrett Lee Smith Memorial Act

  • New York’s Clinic Plus Program

  • State suicide prevention plans

  • 34 National Health and education organizations

  • Suicide Prevention Resource Center

  • Parents

  • Teens


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Presidential Support for Screening 1964–2004 —

- New Freedom Commission on Mental Health -

  • Early detection and treatment of mental disorders can result in a substantially shorter and less disabling course of illness

  • Schools are in a key position to identify mental health problems and provide a link to appropriate services

  • Strong mental health programs in schools can attend to the health and behavioral concerns of students, reduce unnecessary pain and suffering, and help ensure academic achievement

  • The Columbia University TeenScreen Program is highlighted as a model screening program for youth

The President’s New Freedom Commission on Mental Health (July, 2003)


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Federal Support for Screening 1964–2004 —“Garrett Lee Smith Memorial Act”

  • Signed into law on October 21, 2004

  • Authorizes $82 million over 3 years for the development of youth suicide prevention and intervention programs

  • 37 grants totaling $9.7 million awarded for FY 2005 to go towards the development and implementation of youth suicide prevention programs

  • Grants totaling over $14 million awarded in 2006 to 19 states and tribes to support statewide and tribal activities to develop and implement youth suicide prevention and early intervention strategies

  • $2.3 million in GLS funds were also awarded in September 2006 to assist colleges and universities in their efforts to prevent suicide and to enhance mental health services for students

  • Seven states (AZ, NV, NY, ID, WI, OH and MT) and one American Indian Tribe (Standing Rock Sioux) will implement TeenScreen with these funds


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Federal Support for Screening Grows 1964–2004 —SAMHSA and DOE

SAMHSA: Adolescents at Risk Grants

  • Almost $2 million for school districts, tribes and non-profits

  • Awardees include TeenScreen sites in Tulsa, OK and Washington, DC

    DOE Integration of Schools and Mental Health Systems Grants

  • $5 million grant program to increase student access to mental health care through innovative approaches

  • Awardees include TeenScreen sites in Alhambra, CA and Amityville, NY


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New York State 1964–2004 —2006 – 2007 OMH Screening Initiative

$33,000,000 Allocated for Children and Family Clinic-Plus

Goal: With parent consent and youth assent, to increase the number of at-risk children and adolescents screened, assessed and treated for serious emotional disturbance.

Up to 400,000 children screened

Up to 76,000 children assessed

Up to 36,000 additional children admitted to clinic services

Up to 22,400 children receiving in-home treatment services

Services will be provided through combination of 100% state aid and Medicaid rate enhancements.


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State Suicide Prevention Plans 1964–2004 —

  • There are 34 state plans that encourage mental health screening as a means to prevent suicide

  • Of these 34, 5 states specifically mention TeenScreen as a model screening program (FL, IA, NE, NY, VT)


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American Academy of Child and Adolescent 1964–2004 — Psychiatry

American Association for Marriage and Family Therapy

American Federation of Teachers

American Managed Behavioral Healthcare Association

American Mental Health Counselors Association

American Psychiatric Association

American Psychological Association

Anxiety Disorders Association of America

Bazelon Center for Mental Health Law

Child and Adolescent Bipolar Foundation

Children and Adolescents with Attention- Deficit/Hyperactivity Disorder

Consumer Organizing and Networking Technical Assistance Center

Depression and Bipolar Support Alliance

Federation of Families for Children’s Mental Health

Girls and Boys Town

International Association of Psychosocial Rehabilitation Services

International Society of Psychiatric-Mental Health Nurses

National Alliance for the Mentally Ill

National Association of County Behavioral Health Directors

National Association of School Nurses

National Association of School Psychologists

National Association of Secondary School Principals

National Association of State Mental Health Program Directors

National Council for Community Behavioral Healthcare

National Education Association

National Empowerment Center

National Mental Health Association

National Mental Health Consumers’ Self-Help Clearinghouse

President’s New Freedom Commission on Mental Health

School Social Work Association of America

Suicide Prevention Advocacy Network USA

Tara National Association for Personality Disorders

Tourette Syndrome Association

United States Conference of Catholic Bishops

National Support for Screening- Youth Screening Supporters -

July 2006


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TeenScreen History 1964–2004 —

1991: Pilot Study

1995: Public Service Screening Projects

1998: Follow-Up Study

1999: National TeenScreen Program Pilot

2003: National TeenScreen Program Launch


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Columbia University TeenScreen 1964–2004 —

Program Screening Sites

450 Active Sites

43 States and Washington, DC


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Potential Screening Settings 1964–2004 —

  • Schools

  • School-Based Health Centers

  • Doctors’ Offices

  • Clinics

  • Drop-In Centers

  • Shelters

  • Residential Treatment Facilities

  • Juvenile Justice Settings


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Principles of Quality Screening Programs 1964–2004 —

  • Screening must always be voluntary

  • Approval to conduct screening must be obtained from appropriate leadership

  • Staff must be qualified and trained

  • Confidentiality must be protected

  • Parents of identified youth must be informed of the results and offered assistance with securing an appointment for further evaluation


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The Screening Process 1964–2004 —

Debriefing

NoReferral

Middle and High School Age Youth

Parent Consent and

Participant Assent

Screening Questionnaire

Clinical Interview

Parent Notification, Referral and Case Management


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Staffing a TeenScreen Program 1964–2004 —

Staff Roles:

  • Screener(s)

  • Mental Health Professional(s) for Clinical Interview

  • Case Manager(s)

    Sample Staffing Models:

  • Single Staff Model

  • Internal Team Model

  • External Team Model

  • Combination Model

    Anyone can organize a TeenScreen Program, BUT… teachers,

    school administrators, educational staff, and parents cannot

    implement the program


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Parent Consent and Participant Assent 1964–2004 —

  • Parent consent and participant assent are always required

  • TeenScreen requires active written consent for every school that implements the program

  • Assent form is signed by participants before screening begins

    • Teens can refuse participation even if parent consent is granted


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Screening Questionnaires 1964–2004 —

Columbia Health Screen (CHS)

- Suicide risk screen

Diagnostic Predictive Scales (DPS)

- Multi-disorder screen


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CHS Overview 1964–2004 —

14-item, 10-minute, self-completion, paper-and-pencil survey for suicide risk

Appropriate for 11-18 year-olds

6th grade reading level

Trained layperson can administer and score

Assesses for symptoms of depression, anxiety, substance abuse, suicide ideation and past attempts

Highlights those who might be at risk and screens out those who are not

Available in English and Spanish

33% positive rate


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DPS Overview 1964–2004 —

52-item, 10 minute, self-completion mental health screen

Appropriate for 11-18 year-olds

Computer-based with spoken questions

Trained layperson can administer and score

Automatic reporting of screening results

English and Spanish versions available

20-33% positive rate


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The DPS Screens For: 1964–2004 —

Social Phobia

Generalized Anxiety

Panic attacks

Obsessions and Compulsions

Depression

  • Suicide ideation (past month)

  • Suicide attempts (past year)

    Alcohol Abuse/Dependence

    Marijuana Abuse/Dependence

    Other Substances Abuse/Dependence


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In the last 3 months….. 1964–2004 —

Has there been a time when nothing was fun and you just weren’t interested in anything?


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Clinical Interview 1964–2004 —

20-30 minute interview

Conducted by a qualified mental health professional

Review results of the screen and explore the indicated problem area(s) further

Assess level of impairment resulting from symptoms endorsed on the screening questionnaire.

Decide if referral for a complete evaluation is appropriate

Does not represent a clinical diagnosis


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Parent Notification and 1964–2004 —Case Management

  • Notify parents of screening results

  • Inform parents of recommendations for further evaluation

  • Educate parents about their children’s symptoms

  • Connect families with appropriate evaluation services


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Protecting Confidentiality 1964–2004 —

  • ID numbers instead of names used

  • ID log kept separate from screening files

  • Documents stored in separate locked filing cabinets

  • Results not shared with educational staff or included in academic records

  • Release of information signed by parents to release files to third parties


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What Columbia Requires From 1964–2004 —Prospective TeenScreen Sites

  • Quality screening plan with the ability to screen, interview, refer and case manage participants

  • Follow program protocols, policies and practices

  • Annual aggregate screening info and feedback, and participation in quality assurance activities

  • Shared commitment to the goal of routine mental health screening


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A Case Study 1964–2004 —

TeenScreen at NAMI Maine


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Background on Maine 1964–2004 —

Population of Maine=1,321,505

Population of NYC=8,104,079

Population of Chicago=2,862,244


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Suicide Rates (per 100,000) for Maine, Northeast, and the U.S.1983-2003, All Ages, Age-Adjusted


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Age-Specific Suicide Rates (per 100,000) Maine, 1983-2003 U.S.Trailing 5-Year Averages, Ages 10 to 34


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NAMI & TeenScreen U.S.

  • Statewide systems and school knowledge and contacts

  • Consistent with mission

  • Expands and enhances child and adolescent programming

  • Comfort and experience with Advocacy


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Gathering Statewide Support for TeenScreen U.S.

  • Maine Youth Suicide Prevention Program Strategic Plan

  • State Strategic Plan—National Association of State Mental Health Directors

  • Collaborations with Providers, schools, families of children with mental illness and communities


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Support from Schools U.S.

Awareness of the school hierarchy:

  • Superintendent

  • School Board

  • Principal

  • Staff


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Financial Support U.S.

  • State and Federal funding—collaborate with suicide prevention programs; mental health authority; Department of Education, Health and Human Services, Public Health, SAMHSA

  • Private funding—look at suicide prevention; services for children with mental illness; prevention programs


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Opportunities/Lessons Learned U.S.

  • Maine Department of Health and Human Services; Office of Rural Health

    • 1x grant of $40,000

  • Aetna Regional Grant

    • 1 year grant $30,000



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Office of Rural Health, Maine Department of Health and Human Services

  • BE PREPARED

  • Have a statewide view

  • Collaborate with leaders in several areas

  • Promote your program

  • Know your budget


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Aetna Regional Grant Services

  • Use the popularity of the program

  • Take the leap; approach new communities

  • Smaller areas have advantages

  • Identify the leader in new areas

  • A little $ can make a lot of difference


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TeenScreen Program Growth Services

  • Use the momentum of first successes to promote the program

  • Look at ways to ensure the sustainability of the program

  • Keep a statewide programmatic view

  • Prepare the community, look for supporters on the local level


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Learn More! Services

www.teenscreen.org


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