Universal Screening for
Behavior
Illinois Children’s Mental Health
Partnership’s Second Annual School
Mental Health Conference
June 27, 2012
Session Objectives
As a result of attending this presentation,
attendees will:
 Learn the rationale for universal screening
 Acquire information on several evidence based
universal screeners
•
•
•
•
Systematic Screening for Behavior Disorders (SSBD)
BASC-2/BESS
Columbia Health Screen (CHC)
Signs of Suicide (SOS)
 Obtain strategies for successful implementation
and addressing challenges
Universal Screening Defined
“Universal screening is the systematic
assessment of all children within a given
class, grade, school building, or school
district, on academic and/or socialemotional indicators that the school
personnel and community have agreed are
important.”
• Source: Ikeda, Neessen, & Witt, 2009
Rationale: Student Benefits
Associated with Universal
Screening
 “The Commission found compelling research sponsored by
OSEP on emotional and behavioral difficulties indicating that
children at risk for these difficulties could also be identified
through universal screening and more significant disabilities
prevented through classroom-based approaches involving
positive discipline and classroom management.”
Source: U.S. Department of Education Office of Special Education and Rehabilitative Services. (2002). A New Era:
Revitalizing Special Education for Children and Their Families
Rationale: Prevalence Rates
• How prevalent are emotional disorders among
school-age children and youth?
Study
Citation
% of sample
with any
impairment
% of sample
with serious
impairment
Methods for the
Epidemiology of Child
and Adolescent Mental
Disorders (MECA)
Shaffer et al., 1996
21%
5%
Great Smoky
Mountains Study of
Youth
Burns et al., 1995
20%
11%
National Health &
Nutrition Examination
Survey (NHANES)
Merikangas et al., 2010
13%
11%
Rationale: Poor outcomes
associated with delaying
intervention
 “Untreated emotional problems have the potential to create
barriers to learning that interfere with the mission of schools
to educate all children.” (Adelman & Taylor, 2002)
• “Without early intervention, children who routinely engage
in aggressive, coercive actions, are likely to develop more
serious anti-social patterns of behaviors that are resistant
to intervention.” (Walker, Ramsey, & Gresham, 2004)
 Youth who are the victims of bullying and who lack adequate
peer supports are vulnerable to mood and anxiety disorders
(Deater-Deckard, 2001; Hawker & Boulton, 2000)
 “Depressive disorders are consistently the most prevalent
disorders among adolescent suicide victims (Gould,
Greenberg, Velting, & Shaffer, 2003)
.
Rationale: Early intervention
is vital
• Research suggests that there’s a ‘window of opportunity’
ranging between 2-4 years when prevention is critical
Great Smoky Mountains Study: Age Between First Symptom and Initial Diagnosis
Source: O’Connell, Boat, & Warner, 2009
Positive Behavior Interventions & Supports:
A Response to Intervention (RtI) Model
Tier 1/Universal
School-Wide Assessment
School-Wide Prevention Systems
Tier 2/
Secondary
ODRs,
Attendance,
Tardies, Grades,
DIBELS, etc.
Check-in
Check-out (CICO)
Social/Academic
Instructional Groups (SAIG)
Daily Progress
Report (DPR)
(Behavior and
Academic Goals)
Competing Behavior
Pathway, Functional
Assessment Interview,
Scatter Plots, etc.
Tier 3/
Tertiary
Individualized Check-in
Check-out (CICO), Groups, &
Mentoring
Brief Functional Behavior Assessment/
Behavior Intervention Plan (FBA/BIP)
Complex or Multiple-domain FBA/BIP
SIMEO Tools:
Illinois PBIS Network, Revised April 2012
Adapted from T. Scott, 2004
HSC-T, SD-T, EI-T
Wraparound/RENEW
Illinois PBIS Network
Universal Screening Model
 The Illinois PBIS Network recommends a ‘multi-gate’ process for
implementing universal screening for behavior
 Efficient:
• Takes approximately one hour, maximum, per classroom to
complete process
• Less expensive and more timely than special education
referral process
 Fair:
• All students receive consideration for additional supports
(gate one)
• Reduces bias by using evidence-based instrument containing
consistent, criteria to identify students (gate two)
Illinois Universal Screening
Model
Gate 1
Teachers Rank Order
then Select Top 3 Students
on Each Dimension
(Externalizing & Internalizing)
Pass Gate 1
Gate 2
Teachers Rate Top 3 Students in
Each Dimension (Externalizing &
Internalizing) using either SSBD,
BASC-2/BESS, or other
evidence-based instrument
Pass Gate 2
(Multiple Gating Procedure Adapted from Walker & Severson, 1992)
Tier 2
Intervention
Examples of Externalizing
Behaviors:
• Displaying aggression
toward objects or
persons
• Arguing
• Being out of seat
• Not complying with
teacher instructions
or directives
Source: Walker and Severson, 1992
Examples of Internalizing
Behaviors:
• Not talking with other
children
• Being shy
• Timid and/or
unassertive
• Avoiding or
withdrawing from
social situations
• Not standing up for
one’s self
Source: Walker and Severson, 1992
Teacher ranking form:
Externalizers
Teacher Rank Ordering for Universal Behavioral Screening: Externalizers
•
•
•
•
•
•
•
•
•
Property destruction (e.g., damaging books, desks, other school property)
Repeatedly quarrels with peers/adults
Coercion of others (e.g., bullying behaviors includes physical actions and verbal threats)
Regularly does not follow school/classroom rules
Consistent refusal to follow teacher’s directions
Frequently blurts out/speaks in class without permission
Often moves around the classroom/hallways without permission
Spreads rumors with the intention to harm others
Stealing
STEP ONE
Externalizers: Students
regularly displaying at least ONE
of the listed behaviors
STEP TWO
Externalizers: Top three
students regularly displaying
at least ONE of the
listed behaviors
ID #
Race/ethnicity
Teacher ranking form: Internalizers
Teacher Rank Ordering for Universal Behavioral Screening: Internalizers
•
•
•
•
•
Anxious, nervous (e.g., nailbiting, easily startled)
Introverted (e.g., often seen alone)
Rarely/doesn’t speaks to peers
Overly sensitive (e.g., cries easily, has difficulty standing up to others)
Bullied by other students
STEP ONE
Internalizers: Students
regularly displaying at least
ONE
of the listed behaviors
Adapted from Walker and Severson, 1992
STEP TWO
Internalizers: Top
three students
Regularly
displaying at least
ONE
Of the listed
behaviors
ID#
Race/ethnicity
Illinois Universal Screening
Model: Selected Instruments
• Systematic Screening for Behavior Disorders
(Walker & Severson, 1992) for grades 1-6
– Validated by the Program Effectiveness Panel of the U.S. Department of
Education
– Six research studies confirm the SSBD’s ability to systematically screen
and identify students at-risk of developing behavior problems
– Universal screening with the SSBD is less costly and time-consuming than
traditional referral system (Walker & Severson, 1994)
– Inexpensive
• Manual= $ 131.49 (includes reproducible screening forms)
– Quick
• Entire screening process can be completed within 45 minutes to 1
hour per classroom
Illinois Universal Screening
Model: SSBD Administration
Teachers complete Critical Events Index
checklist for top three internalizers and
externalizers
 Internalizers with four or more and
externalizers with five or more critical events
immediately pass gate two and are eligible for
simple a secondary intervention (i.e., CICO)
Sample of SSBD Critical
Events Form
Illinois Universal Screening
Model: SSBD Administration
Teachers complete the Combined
Frequency Index scale for internalizers and
externalizers who did not initially pass gate
2
 Students who subsequently pass gate 2 meet
the following criteria:
• Internalizers with Adaptive scores of ≤41 and
Maladaptive scores of ≥; Externalizers with
Adapative scores of ≤30 and Maladaptive scores of
≥35
Sample of SSBD CFI Form
Illinois Universal
Screening Model:
Selected Instruments
• BASC-2 Behavioral and Emotional Screening System (BESS)
(Kamphaus & Reynolds, 2007)
 Developed as a school-wide (Universal) screening tool for
children in grades Pre-K to 12
• Similar to annual vision/hearing screenings
 Identifies behavioral and emotional strengths and
weaknesses
• Externalizing behaviors (e.g., acting out)
• Internalizing behaviors (e.g., withdrawn)
• Adaptive skills (e.g., social and self-care skills)
Illinois Universal Screening
Model: BASC-2/BESS
Administration
 Teachers complete scantron forms (‘bubble sheets’) for
each student in their class
 Or, for top three internalizers and externalizers if using
a multi-gate approach
 Takes approximately five minutes, or less per student to
complete ratings
Illinois Universal Screening
Model:
BASC-2/BESS Sample
Illinois Universal Screening
Model: BASC-2/BESS
Administration
 The BASC-2/BESS uses T-scores to communicate results
relative to the average (mean=50)
 Identifiers and percentile ranks are provided for ease of
interpretation
 Normal risk level: T-score range 10-60
 Elevated risk level: T-score range 61-70
 Extremely Elevated risk level: T-score range ≥ 71
Illinois Universal Screening
Model: BASC-2/BESS
Administration
 Students who score within the Elevated, or Extremely
Elevated risk levels would be considered as eligible for
simple secondary intervention (i.e. CICO)
Illinois Universal Screening
Model: Implementation
Summary
•
During the 2010-11 school year, 61 Illinois schools screened
approximately 28,000 students representing a diverse demographic
profile:
• White, 32%
• Black/African American, 20%
• Hispanic/Latino, 38%
Source: ISBE 2011 Fall Housing Report
Illinois Universal Screening
Model: Universal Screening
Results
Illinois PBIS Network Schools 2008-11
10%
70
61
8%
40
30
30
4%
2%
50
45
6%
60
20
18
10
0%
0
2007-08
Internalizers
2008-09
Externalizers
2009-10
Total
2010-11
Number of Schools Screening
Universal Screening: What do
implementers think?
The Illinois PBIS Network recently surveyed*
staff at 60 Illinois schools regarding their
experience with universal screening for
behavior (i.e. the IL-PBIS Network model using
the SSBD, or BASC-2/BESS instruments)
 Respondents (N= 582) were involved with the
universal screening process in the 2010-11 and/or
2011-12 school year
• Majority (82%) of respondents were teachers
•
*Preliminary results from a screening tool adapted from Caldarella, P., Wall, D. G., Christensen, L., Hallam, P. R.,
& Young, B. J. (2010, October). General Educators’ Perceptions of the Systematic Screening for Behavior
Disorders (SSBD). Paper presented at the annual Teacher Educators for Children with Behavior Disorders
Conference, Tempe, AZ.
Universal Screening: What do
implementers think?
Key findings:
 “Universal screening for behavior is consistent
with our school’s mission” (72%)
 “Universal screening is appropriate for a variety
of children” (64%)
 “Universal screening is beneficial for students
exhibiting overly introverted, anxious, or
depressed behaviors” (58%)
 “The amount of time required to complete the
universal screening tool was reasonable” (63%)
Universal Screening: What do
implementers think?
 “I believe that universal screening is a beneficial
tool for students with difficulties, especially
emotional, in that it gives specific data to assist the
student.”
 “I am so pleased that our school has used this as a
means for identifying our students who need
interventions.”
 “Universal Screening allows for input by a variety of
school personnel. This is valuable since different
settings create different behaviors in individuals in
accord with experiences and comfort levels.”
Universal Screening: What do
implementers think?
 Key areas of concern identified in the survey were:
 Timing for executing universal screening
• Completing universal screening too early in the year before
staff is knows the students in their class(es)
• Too much lag time between screening and implementing
interventions
 Having adequate staff to implement interventions
 Lack of effective interventions (especially for
internalizers)
 Not providing interventions for identified students
 Results of universal screening process were not shared
with staff
Universal screening readiness
checklist
Universal screening readiness
checklist
Build a foundation
 Secure district and building-level administrative support for
universal screening
 Establish universal screening committee consisting of district and
building-level administrators, student support personnel, teachers,
family and community representatives and assign roles
Clarify goals
 Identify purpose of universal screening (e.g., mental health, social
skills assessment)
 Determine desired outcomes
Universal screening readiness
checklist
Identify resources and logistics
 Identify resources for supporting students identified via screening
(in-school and community-based)
 Create a timeline for executing screening process including
frequency of screening (e.g., once, or multiple times per year?)
 Develop budget for materials, staff, etc.
 Create administration materials (e.g., power point to share process
with staff, parents and community members, consent forms,
teacher checklists)
 Schedule dates for screening(s) and meetings to share school-wide
results
Universal screening readiness
checklist
Select an evidence-based screening
instrument
Use The Standards for Educational and
Psychological Testing, or resources from other
professional organization resources (e.g.,
National Association for School Psychologists; NASP),
as guidelines for selecting an appropriate
screener
Universal screening readiness
checklist
Data
Develop data collection and progress
monitoring system
Determine systematic process for using results
to inform interventions
Plan for sharing screening and progress
monitoring results with staff and families
Universal Screening: Illinois PBIS
Network Current Screening Instruments
Screener
Pros
Cons
Systematic Screening for Behavior Disorders
(SSBD; Walker & Severson, 1990)
http://store.cambiumlearning.com
•
Well-validated (Endorsed in 1990 by
the Program Effectiveness Panel of
the U.S. Department of Education)
Efficient (Screening process can be
completed within 45 minutes to 1
hour)
Most effective instrument for
identifying internalizers (Lane et al.,
2009)
Meets AERA/APA instrument
selection criteria
Inexpensive (Manual= $ 134.49;
includes reproducible screening
forms)
•
•
•
Measures behaviors associated with
internalizing and externalizing
problem behaviors and academic
competence
Meets AERA/APA instrument
selection criteria
Incorporates three validity measures
to rule out response bias
Utilizes large (N= 12,350 children &
youth), nationally-representative
sample
Web-based screening capacity
available via AIMSewb
• Can be expensive for districts/schools
that don’t have access to a scantron
machine
• $26.25 for 25 hand-scored protocols
• Online access via AIMSweb:
Additional $1.00 per student for
subscribers and $4.00 per student for
non-subscribers)
• Hand-scoring is time-consuming and
reduces access to validity measures
• Computer software is expensive
($620)
•
•
•
•
BASC-2/BESS (Kamphaus & Reynolds, 2007)
http://www.pearsonassessments.com
•
•
•
•
•
Normed for grades 1-6
Dated norms (normed in 1990)
Normative sample skewed to
western U.S. region
Universal Screening: Illinois PBIS Network
Additional Evidence-Based Screening
Instruments
Screener
Strengths and Difficulties Questionnaire
(SDQ; Goodman, 2001)
http://www.sdqinfo.org
Pros
• Measures internalizing/externalizing
behaviors
• Free
• Option of completing pencil and paper, or
online version
• Can be scored online
• Technically sound: Large, representative
normative group
Cons
• Perceived length of administration time
• Items skewed toward externalizing
behaviors
Student Risk Screening Scale (SRSS;
Drummond, 1993)
• Measures internalizing/externalizing
behaviors
• Free
• Quick to administer (less than 5 minutes
per student; 15 minutes for entire class,
depending upon number of students)
• Easy to understand and interpret score
results
• Technically-adequate
• Not as accurate as the SSBD regarding
identification of internalizers
Social Skills Improvement System (SSIS;
Gresham & Elliott, 2008)
http://psychcorp.pearsonassessments.com/
pai/ca/cahome.htm
• Measures problem behaviors, social and
academic competence
• Computer and web-based (AIMSweb)
administration and scoring available
• Expensive: Technical manual=$105.60;
Rating forms= $43.75 for package of 25
hand-scored forms; scoring software=
$270.00; Scanning software= $640
Contact Information
Jennifer Rose, Ph.D., Illinois PBIS Network,
jen.rose@pbisillinois.org
Implementation of Universal Screening
Mental Health America of Illinois’
TeenScreen Program
Carol Gall, MA
Executive Director
Who is Mental Health
America of Illinois?
•*Formerly Mental Health Association in Illinois
•Statewide, non-profit organization founded in 1909 –
Celebrating over 100-Years of Service in Illinois!
•Mission is to promote mental health, work for the
prevention of mental illnesses, advocate for fair care and
treatment of those suffering from mental and emotional
problems.
•Engage in public education, prevention, and advocacy.
1
History of TeenScreen
• TeenScreen developed in 1991 as a result of Dr. David Shaffer’s research on
mental illness & suicide in youth
• 90% of youth who died by suicide suffered from a treatable mental illness
•65% experience symptoms for at least a year prior to their deaths
•This shattered the myth that suicide is a random and unpredictable event in
youth
•Found there is time to intervene with at risk youth, connect with treatment,
Potential to save lives
1
History of MHAI’s Screening Programs
• In 2007, MHAI launched it’s pilot TeenScreen Program at Cameron Elementary
School in Humboldt Park
•MHAI is now 1 of 900 sites in 43 states to implement the TeenScreen Program, and
1 of 5 in Illinois
•Program expanded to 3 schools in 2011 school year - Cameron Elementary in
Humboldt Park, Buckingham Special Education Center in Calumet Heights and
Burnham/Anthony Mathematics and Science Academy in South Deering
•Majority of students screened are African-American and Latino-American
populations; are on Medicaid; live in lower SES communities
1
•In 2009, MHAI began conducting screenings at Oak Lawn Community High School,
screening all freshman students utilizing the Signs of Suicide screening tool &
incorporating aspects of TeenScreen
Why Screen for Mental Illness and Suicide
Risk?
• Mental illnesses are treatable.
• Screening tools that effectively and accurately identify at-risk
teens are available.
• Most mentally ill and suicidal youth aren’t already being
helped and are not necessarily asking for help when needed.
• http://www.teenscreen.org/library/pressreleases/proactive-screening-more-effective-inidentifying-students
• No one else is asking teens about these issues, but they will
give us the answers if we ask the questions.
The National Research Council and the Institute of Medicine of the National Academies. (2009).; Anderson 2004; YRBS 2005; U.S. Census 2003
Why Implement Universal Screening?
•One in five teens suffers from clinical depression
•Each year almost 5,000 teens in the U.S. die by suicide
•80% of youth give clear warning signs before a suicide attempt
•For every one youth that dies by suicide, an estimated 100
attempt; compare this to adults – for every one adult that dies
by suicide, an estimated 25 attempt
•70% of youth who make a suicide attempt are frequent users of
alcohol and/or other drugs
1
Why Implement Universal Screening?
1
Child Health Data Lab www.chdl.org/yrbs.htm
Why Implement Universal Screening?
1
Child Health Data Lab www.chdl.org/yrbs.htm
Why Implement Universal Screening?
1
Child Health Data Lab www.chdl.org/yrbs.htm
Why Implement Universal Screening?
1
Child Health Data Lab www.chdl.org/yrbs.htm
Principles of Quality Screening Programs

Screening must always be voluntary

Approval to conduct screening must be obtained from
appropriate leadership

All screening staff must be qualified and trained

Confidentiality must be protected

Parents of identified youth must be informed of the
screening results and offered assistance with securing an
appointment for further evaluation
The TeenScreen Screening Process
Select Your Screening Questionnaire
CHS Overview
•
•
14-item, 10-minute, self-completion, paper-and-pencil
survey for suicide risk
Requires active parental consent, participant assent
•
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
CHS Sample Question
Signs of Suicide (SOS)
•
Developed by Screening for Mental Health, Inc.
•Dedicated
to promoting the improvement of mental health by providing
the public with education, screening, and treatment resources
•National
Depression Screening Day; Military, Workplace and Healthcare
screening tools, middle and high school screening tools, etc.
•
Requires passive parental consent, student assent
•
Appropriate for middle and high school aged youth
•
9 items, 5-minute, self-completion, paper-and-pencil survey for
suicide risk
•Questions
pertaining to depression, suicide ideation/attempts,
alcohol abuse
•
Does not require all participants to receive follow-up interview
Signs of Suicide (SOS)
Prepare Your School to Implement a
Universal Screening
• Raise awareness and build school/ community support
• Present current research to all faculty/staff at school
• Present information to parents/families during school events -
parent/teacher conferences, open house, college nights, etc.
• Choose a staffing model and identify your team
• Who will participate in screenings, interviews, follow-up?
• What are your school/district crisis protocols?
• Select your screening population, location, schedule and
questionnaire
• What tool? Which grades/classes? Which rooms/spaces?
• Develop a referral network and community resource guide
• Begin developing relationships with community providers to facilitate
referrals process
• Locate agencies that might provide in-school services to streamline
process
Establishing a Strong Foundation for
Universal Screening
• Administrative Support
• School Staff
• Parents/Caregivers and Youth
• Key Stakeholders
• Medical Providers
• Mental Health Providers
• Community Agencies and Organizations
Educate and Engage School Personnel
• Teachers, administrators, and school health and mental
health staff can dramatically influence the success of your
TeenScreen program.
• Inform school personnel of your plans to implement
TeenScreen and obtain their support for and commitment
to your efforts.
• Build working relationships with school personnel.
• Present your plans at a faculty meeting and/or
department meetings.
Seek Advice and Help from School Personnel
• Ask school personnel how they think parents will react to
screening and how best to reach parents and teens.
• Ask for assistance with promoting the program to parents
and teens and with distributing and securing the return of
parent consent forms.
• Help and buy-in is especially critical from the teachers
whose classes will be impacted by consent distribution or
screening.
Educate and Engage Parents
• Know your community and share key facts specific to your
community with parents to educate them about the need for
screening.
• Present information about TeenScreen at a school PTA/PTO
meetings to raise awareness and build support prior to consent
distribution.
• Have a TeenScreen information table at parent orientations,
registration days, report card pick-up, or back to school nights.
• Make yourself available to answer questions or address
concerns about screening .
• Present information in a culturally appropriate manner and
anticipate how different cultural groups will respond to
screening.
Developing a Mental Health Referral
Network and Community Resource Guide
Key Points:

The Referral Network should include providers for insured and uninsured
teens

Develop relationships with providers in your community who:

Evaluate and treat a variety of conditions

Agree to accept your referrals in a timely manner and do not have
long wait lists

Are culturally appropriate
The Community Guide should include a variety of resources relevant to
parents and their teen

Planning Questions:
1.
2.
Have you contacted mental health providers for your referral network?
Have you identified community resources to enhance your services and
provide additional linkages and resources to at-risk teens?
Facing Challenges with Administrators
•“Our students don’t experience mental illnesses, suicidal thoughts, etc.”
•Research shows that one in five adolescents nationwide will experience a mental illness
in any given year, regardless of race, ethnicity, religion or socioeconomic status
•“Our students will not be honest on a questionnaire about their mental health.”
•Research shows us that teens in need of help have been accurately and effectively
identified through screening tools and that without the tool, do not ask for help nearly as
much on their own
•“What do we do when we find 20-30% of our students need follow-up? We don’t have
those resources.”
•When we create our screening program, we put together our procedures and policies.
We follow our normal crisis procedures for students at highest-risk and in crisis. We
build relationships with local providers to facilitate referrals for families. We provide inschool follow-up for students at lower levels of risk.
•“It’s not the school’s job to screen students for mental health issues.”
•90% of parents believe not enough is being done to identify youth at risk (JAMA)
•By offering students/families this opportunity, we communicate to them that we care,
and that we can talk about these issues openly, and we can prevent future suicides
Facing Challenges with Parents
•“Is this safe?”
•Screening for mental health issues has been shown to be a safe and effective method of
early identification of mental illness and suicide prevention. We have found that youth
who participate are not more likely to feel distressed after participating, and actually
report feeling more comfortable addressing concerns in the future.
•“I know my child best, I would know if my child needed help.”
•Sometimes symptoms can present in disguise - the child that seems to be “lazy” may be
lacking motivation and energy due to symptoms of depression, the child that seems
easily irritated and has begun arguing with you more may not be experiencing “normal
adolescence,” but rather irritability and mood swings found in depression. The child
whose grades are dropping recently may be due to lack of concentration in school and at
home, also a symptom of depression.
•STIGMA - The more we educate, the more we break the stigma
•Using words appropriate for the culture of your community can assist in breaking down
barriers - perhaps emotional wellness and less threatening than mental health, and so
forth.
•Offer opportunities for parents to meet/speak with those coordinating the screening to
ask questions, and receive education
Talking Points
• Behavioral/emotional disturbances in teenagers (depression, substance abuse, etc.)
is highly correlated with school failure and dropout, affiliation with peers in risky
behaviors, teen pregnancy, and chronic mental health disorders
•
•
Approximately 50% of students age 14 and older who suffer from a mental illness
drop out of high school; this is the highest dropout rate of any disability group.
Similarly, mental illnesses are a significant predictor of failure to enter college and
graduate college.
Many teens experience the irritable/angry symptoms of depression, which
contributes to more arguments/fights at home and in school
• Complications of untreated teen depression are far-reaching and may affect many
aspects of a young person's life, including:
•
•
•
•
•
•
•
School absenteeism and decreased performance.
Strained relations with parents and siblings.
Withdrawal from peers leading to reduced support systems.
Emotional distress.
Increased chance of smoking and excess alcohol and drug use.
Potential for suicide - 90% of teens who die by suicide had a mental illness
Limited or non-existent employment opportunities
• Many youth with unidentified and untreated mental illness end up in jail and
prisons. 65% of boys and 75% of girls in juvenile detention suffer from a mental
illness.
MHAI Screening Data 2007-2011
•2,300 6th-9th graders offered screening through parental
consent at their school
•2,000 students participated in screenings
•400 students scored positive
•361 referred for some form of follow-up services - mental
health evaluation, primary care visit, in-school services,
vision/dental/hearing, after-school activities, etc.
•250 families followed up with service recommendations
and attended at least one appointment
MHAI Case Example
Fourteen year-old Sara* was a freshman student at her high
school in the suburbs. She appeared to be adjusting well to highschool - she was maintaining good grades, had made a few good
friends she could talk to and stayed out of trouble at school.
Through the screening, she revealed she was struggling with
feelings of sadness, nervousness and had suicidal thoughts.
During her interview, she revealed she had made an aborted
suicide attempt - impulsively wrapping a belt around her neck and
considering attaching it to the shower pole. She decided against
going any further as she wasn’t sure it would work. Her parents
were unaware of her attempt, or even how she had been feeling
lately. Sara reported her parents are very hard workers and can be
strict about her homework and how much time she spends with
friends. She had tried before talking to her parents about her
desire to be more social, but the talks usually ended in arguments.
MHAI Case Example
She didn’t know how to handle her frustration as she worried
about fitting in in high school if she never was allowed to see her
friends outside of school. She worried her parents were
disappointed in her and her drive in school and she felt
disconnected. Her suicidal gestures were impulsive and screening
staff were concerned about her acting impulsively again.
Staff spoke with Sara regarding their concerns and that they
wanted to share this information with Sara’s parents. Sara felt
very nervous about this and worried her parents would be further
disappointed. After discussing her concerns further, Sara felt more
comfortable with the screening staff sharing their concerns and
she expressed relief that she wouldn’t have to be the one to share
about her suicide attempt. The screening staff helped school
personnel in contacting Sara’s parents.
MHAI Case Example
They were shocked to hear this news, but more so, they were
concerned. They discussed their family’s culture surrounding time
designated for school work versus time dedicated to socializing,
and challenges they had faced with their children, as both parents
were immigrants to the U.S. Staff encouraged Sara’s parents to sit
down and talk openly about the screening results and gauged her
parents’ interest in receiving highly recommended follow-up
services. Sara’s parents were open to this recommendation and
were provided with a few local community mental health agencies.
Follow-up with Sara’s parents revealed that Sara had attended an
initial assessment with a counselor and they were going to be
working together to address her feelings of sadness and her coping
skills.
Teen Support for Screening
- What Teens Say About TeenScreen Feedback from MHAI’s TeenScreen Program Participants:
•“I liked participating in TeenScreen because I felt like it
wouldn’t just help me, it will help my family as well.”
•“I feel it is important for students my age to have a mental
health check-up because some people don’t have people at
home to talk to.”
•“I feel it is important for students my age to have a mental
health check-up because if you don’t have physical and mental
health check-ups, all of these bad and negative thoughts can
build up inside of you and cause major problems in
adulthood.”
•“TeenScreen is a good use of class time because I feel relief
that I was able to tell someone what I did. This was more
important to me than class.”
•“TeenScreen is a good use of class time because students
may need to get something off their chest that may be
disturbing their work.”
•“The best part about TeenScreen is that I was asked questions
I’m not always asked.”
Resources
Columbia TeenScreen National Center for Mental Health Checkups
www.teenscreen.org
Resources for parents:
http://www.teenscreen.org/library/implementation-materials-fact-sheets/152schools-a-communities-faqs-for-parents
Resources for School Administrators:
http://www.teenscreen.org/library/implementation-materials-factsheets/schools-and-communities/faqs-school-admin
Screening for Mental health, Inc.
www.mnetalhealthscreening.org
It Only Takes One
www.itonlytakesone.org
For Teens:
Reach Out - We Can Help Us
www.reachout.com
Erika’s Lighthouse
www.erikaslighthouse.org
Thank you!
Carol Gall, MA, Executive Director
cwoz@mhai.org ext.324
Katie Mason, LPC, Program Director of Public Education
and Disaster Mental Health
kmason@mhai.org ext.322
Mental Health America of Illinois
312-368-9070
www.mhai.org