Transcript Implementation of Universal Screening A Community / School Partnership Fond du Lac TeenScreen Program Marian Sheridan Matt Doll.

Implementation of Universal Screening
A Community / School Partnership
Fond du Lac TeenScreen Program
Marian Sheridan
Matt Doll
Reflection Questions
•What, if any, roadblocks to universal
screening for behavior exist in your
district/school?
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Potential Roadblocks
• Absence of administrative support
• Lack of knowledge regarding the
process
• Fear of ‘labeling’ students
• Apprehension regarding parental/guardian
response
• Concerns regarding cost/time to implement
universal screening
Why Screen for Mental Illness and Suicide
Risk?
• Mental illness is treatable.
•
There is ample time to intervene before symptoms escalate to a full blown disorder and
before a teen turns to suicide.
• Screening tools that effectively and accurately identify at-risk teens are available.
•
Screening more accurately identifies teens with significant mental health problems than
school professionals (63% vs. 37%; Scott et al., AJPH 2009).
• Most mentally ill and suicidal youth aren’t already being helped.
•
At-risk adolescents who do not request help on the screening questionnaire are
significantly more likely to report suicidal ideation in the preceding three months than
those who request help (62% vs. 31%; Husky et al., Child Psychiatry Hum Dev, 2008).
• No one else is asking teens about these issues, but they will give us the answers if we
ask the questions.
•
Screening is safe and does not increase distress, depressive symptoms, or suicidal
ideation (Gould et al., JAMA 2005).
The National Research Council and the Institute of Medicine of the National Academies. (2009).; Anderson 2004; YRBS 2005; U.S. Census 2003
Challenges of Implementation
•
Stigma of Mental Health
• Lack of knowledge
•Economic (Cost of non-action, Funding)
•Partnerships (sand box politics)
•What will we do if we identify
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Stigma
•Weak to ask/get help
•Weak to be affected
•Negative impact on future career (military)
•All or None – “I’m fine” or “I’m a Wreck”
•Poor Past Experience (treatment, school)
•Fear of Agents of Social Control (DSS)
•Labeling
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Stigma
•Not in Our Community
•Not in My Family
•Not in My Child
•67% of 17,000 people reported at least on ACE (
Adverse Childhood Event), 87% more than one ACE
(abuse, family dysfunction etc.)
•If we consider; self, family, friends...100% touched by
mental health
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Knowledge: Five Things To Remember
•
Neurodevelopment Processes
• Genetic predisposition exasperated by environmental
influences (Nature And Nurture)
• Long term negative outcomes for physical health, emotional
health and society for bad things happening to children.
• Long term positive outcomes when good things happen,
potentially protective as well.
• These issues impact us all; no social, economic or cultural
group is immune
Knowledge: Across the Lifespan
•
Intrauterine Experience - Heart Disease, Obesity, Diabetes,
Pollution, Mental Illness.
• Adverse Childhood Experiences (ACE) - long-term changes
in brain structure and function. 67% of all of us (87% < 1 ACE).
65% experience symptoms for at least a year prior to their
deaths
•Mortality - Individuals with an ACE score of 6 and higher had a
lifespan almost 2 decades shorter than seen in those with an
ACE Score of 0 but who otherwise have similar characteristics.
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Knowledge: Why It Matters
•
Until recently, the persistent effects on neurodevelopment were
“hidden” from the view.
• Now that we have the knowledge, we have the
responsibility to use it. 65% experience symptoms for at least
a year prior to their deaths
•If we can think long term instead of short term, our
community’s social, emotional, health and economic welfare will
benefit.
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Start with building a strong
community / school partnership
• Select Key Area Representatives
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Business (Sustainability)
School (Staff, Leadership)
Clergy ( Community)
Mental Health (Public, Private)
Post Secondary schools (Interns, Research)
Other (Potential Sticking Points)
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
Social/Academic
Instructional Groups
Daily Progress
Report (DPR)
(Behavior and
Academic Goals)
Competing Behavior
Pathway, Functional
Assessment Interview,
Scatter Plots, etc.
Individualized CheckIn/Check-Out, Groups &
Mentoring (ex. CnC)
Tier 3/
Tertiary
Brief Functional Behavioral Assessment/
Behavior Intervention Planning (FBA/BIP)
Complex FBA/BIP
SIMEO Tools:
HSC-T, RD-T, EI-T
Wraparound
Illinois PBIS Network, Revised August 2009
Adapted from T. Scott, 2004
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
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Why Implement TeenScreen?
One in five children has a mental or emotional problem that
requires treatment
At least one in 10 may have a serious emotional disturbance
that significantly impairs his or her ability to function emotionally,
socially or academically
Two-thirds of children needing mental health treatment go without
Children with mental health problems are not “just being
children.” Mental health problems can disrupt daily functioning
at school, at home and with peers.
Suicide is the second leading cause of death for adolescents
in Wisconsin.
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Principles of Quality Screening Programs

Screening must always be voluntary
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Approval to conduct screening must be obtained from
appropriate leadership
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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
Prepare Your School to Implement a
Universal Screening
• Raise awareness and build school/ community
support
• Choose a staffing model and identify your team
• Select your screening population, location,
schedule and questionnaire
• Develop a referral network and community
resource guide
Establishing a Strong Foundation for
Universal Screening
• Administrative Support
• School Board Members
• Key Stakeholders
• Medical Providers
• Mental Health Providers
• Community Agencies and Organizations
Purpose of Advisory Committee
•Shared Agenda
• Problem Solve Roll Out Issues (confidentiality)
•Problem Solve Ongoing Issues (stigma)
•Collect & Analyze Program Data (refusals)
•Sustainability Issues
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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 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.
The Screening Process
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
Select Your Screening Questionnaire
CHS Overview
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14-item, 10-minute, self-completion, paper-and-pencil
survey for suicide risk
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Appropriate for 11-18 year-olds
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6th grade reading level
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Trained layperson can administer and score
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Assesses for symptoms of depression, anxiety, substance
abuse, suicide ideation and past attempts
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Highlights those who might be at risk and screens out those
who are not
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Available in English and Spanish
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33% positive rate
CHS Sample Question
DPS Overview
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52-item, 10 minute, self-completion mental
health screen
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Appropriate for 11-18 year-olds
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Computer-based with spoken questions
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Trained layperson can administer and score
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Automatic reporting of screening results
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English and Spanish versions available
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20-33% positive rate
The DPS Screens For:
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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Developing a Mental Health Referral
Network and Community Resource Guide
Key Points:
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The Referral Network should include providers for insured and uninsured
teens
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Develop relationships with providers in your community who:
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Evaluate and treat a variety of conditions
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Agree to accept your referrals in a timely manner and do not have
long wait lists
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Are culturally appropriate
The Community Guide should include a variety of resources relevant to
parents and their teen
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Planning Questions:
1.
Have you contacted mental health providers for your referral network?
2.
Have you identified community resources to enhance your services and provide
additional linkages and resources to at-risk teens?
Fond du Lac County Data 2002present
Over 6,061 students in FDL County have been screened
1,105 (18%) of these students have been identified for being
at potential risk of suicide, suffering from mental health
problems and received a referral for further evaluation and
appropriate treatment.
Playing in the Sandbox of Life
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Ownership; data, license, ….
Roles; screening not mental health diagnosis
Follow Up; referral options…..
Interview Questions & Forms
Best Practice Procedures
Community/Professional Education
Playing in the Sandbox of Life (cont)
• I Don’t Want to Know – I’ll Have to Do Something
• I Don’t Want you to Know – I’ll Have to Do
Something
• Clearly Define Follow-up Procedures
• Shared Responsibility – Less Weight for All
• Communication/Relationship Dividends
• Systemic Improvements
Teen Support for Screening
- What Teens Say About TeenScreen “I feel like someone is paying attention and listening to
me.”
“I thought it was very helpful, and I finally feel relieved
because I’m getting my problems out.”
“The interview on the computer was a great way to know
how we feel about stuff in our lives. I think it’s a great
idea.”
“I thought it was insightful because some of these things
are not talked about enough.”
“I think this is a good way to find out what’s going on
with teens these days. Most teens are afraid to talk about
their problems because they don’t want other teens to
think they are different.”