Adolescent Mental Health screening.

It is estimated that ten percent of adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school and with peers, (Mental Health: A Report of the Surgeon General, 1999) and only 20% of those adolescents with mental disorders are identified and receive mental health services, (Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda, 2000). Therefore it is critical that health care professionals, schools, parents, and communities explore options to identify and provide interventions for all adolescents. The shortage of mental health providers or the weeks of waiting to be seen should not excuse professionals from seeking other options to identify and intervene on behalf of all adolescents. Early identification of mental health concerns allows for early interventions and optimal outcomes.

Mental health concerns include diagnosable emotional, behavioral, and mental disorders. Behavioral and mental disorders left unidentified and untreated can create a chain of events contributing to violent or suicidal behavior or develop into severe problems during adolescence and into adult years. Particularly if not recognized and treated, these concerns may affect a young person's self-esteem, ability to maintain relationships and their success in school. In fact, in 2005 approximately 17% of US students in 9-12th grade reported seriously considering suicide in the previous 12 months (Centers for Disease Control and Prevention, www.cdc.gov). Suicide is the third leading cause of death for 15-24 year olds in the US but in Iowa, suicide is the second leading cause of death of 15-24 year olds (Iowa Department of Public Health, www.idph.state.ia.us). It is important to note that mental health concerns in adolescents encompasses more than depression and suicide. Many adolescents struggle with other mental health concerns including, but not limited to, anxiety, social phobia, or alcohol or other substance abuse.

For many, exactly how to identify and provide early interventions remains unclear but the use of the TeenScreen mental health screening program is an excellent starting point. TeenScreen is overseen by Columbia University in New York with over 450 established screening programs in 43 states and initiation of screening programs overseas (www.teenscreen.org). TeenScreen is research-based, provides three different screening tools, and the screening process is thorough including a focused interview with a licensed mental health therapist immediately after screening if needed. TeenScreen does not provide a diagnosis but rather identifies areas of concern that may need further evaluation. The goal is early identification and early intervention, not always requiring medications. TeenScreen requires active consent from parents and assent from the participating adolescent. TeenScreen works by creating partnerships within communities to implement local screening programs for adolescents. Schools create a unique venue to offer mental health screening since most adolescents attend school. By following TeenScreen's requirements for establishing a screening site, schools can ensure appropriate and confidential screening and openly communicate concerns with parents. Other communities have chosen to implement the program in doctors' offices, clinics and juvenile justice facilities. Just as vision, hearing, and other physical screenings are part of health check-ups, it is essential that mental health screening becomes another standard of health checkups for all ages.

Several other mental health screening tools are available but after personal review, I adopted the TeenScreen DPS-8 screening tool and implemented at Xavier High School in February 2004. TeenScreen was my screening tool of choice because it is research-based, encompasses more than depression and suicide screening, and screening can be conducted using computers to make the screening process more efficient. Establishment of a TeenScreen program requires a team approach including the site coordinator, screener, licensed mental health clinical interviewer, and case manager. Based on screening results (available immediately after screening), students with areas of concern visit with the licensed mental health clinical interviewer on-site and then the case manger follows up with parents informing them of screening results indicating areas of concern. Implementing mental health screening allowed me to identify adolescents with mental health concerns who were otherwise not known. I have witnessed the impact that TeenScreen has on early identification and intervention for adolescents with mental health concerns ranging from active suicide ideation to anxiety preventing a teen from usual teen activities.

In 2007, INA was presented with a resolution to support TeenScreen for mental health screening in Iowa. This resolution was reviewed and adopted at the October 2007 INA Convention. While you may not be a school nurse, work directly with adolescents, or practice primarily in mental health, your support and advocacy for mental health screening using TeenScreen are essential to identifying adolescent mental health concerns in Iowa. Ask around your community to see what is being done about mental health screening and mental health services for youth. Get involved by offering to help develop a plan for your community. We cannot afford to pretend adolescent mental health issues do not exist. Iowa can and should be a leader in mental health screening using TeenScreen.

By Sharon Yearous, PhD(c), ARNP, CPNP, NCSN

Iowa School Nurse Organization Executive Director