When Columbia University’s TeenScreen program announced last month that it was shutting down effective December 14, everyone, including the Substance Abuse and Mental Health Services Administration (SAMHSA), was surprised. Mark Olfson, M.D., interim executive director of TeenScreen, referred interview requests to the Columbia University press office, where spokesman Doug Levy said that no interview requests would be granted.

Overall, there was shock that the program, which according to the website had contracts with 550 school districts to conduct mental health screening on middle and high schoolers and refer them to treatment if necessary, was suddenly coming to such an abrupt end.

However, mental health groups said TeenScreen’s loss, despite its controversies, would hurt children who had been helped by the program. “TeenScreen is a great program,” said Rob Grant, spokesman for the American Academy of Child and Adolescent Psychiatry (AACAP). Grant was as surprised as everyone else by the announcement of the shutdown. “I found out the same way the rest of the world found out,” he told MHW. “I went online, and within five hours their social media footprint was gone. I have no knowledge of their internal workings,” he said. “But it was a great resource for getting information out to the public. We would share information whenever we could.”

Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness (NAMI), said that TeenScreen has “led the movement for routine mental health screening and for suicide prevention.” Although NAMI was a TeenScreen partner, Fitzpatrick had no knowledge of the reasons for the shutdown. Schools are ideally the best place to do this kind of screening, said Fitzpatrick, “because that’s where the children are.”

For example, since 2006, 2,527 teens had been screened in northern Iowa, and of that group 460 had screened positive, according to Jennifer Kammeyer, chief professional officer of United Way of North Central Iowa. Of those, 201 had been referred to treatment. “We’re sick” about the closing, Kammeyer said in an email to MHW. Schools in northern Iowa receive $45,000 a year from United Way to implement TeenScreen.

TeenScreen has been used in SAMHSA grant programs, primarily through the Garrett Lee Smith Memorial Act, signed by President Bush in 2004 and named for the son, who died by suicide, of then-Sen. Gordon H. Smith (R-Oregon). In addition to whatever Columbia University provided, the law required additional funding for the interventions, and most of it went to TeenScreen, said Richard McKeon, Ph.D., SAMHSA branch chief for suicide prevention. “Our grantees who are doing suicide prevention are using TeenScreen,” McKeon told MHW.

Consent

Before a teen is screened, parents must provide consent, said McKeon. But prior to 2009, consent could be “passive,” which led to an outcry in some schools by parents. In other words, the school would send a form home for the parents to sign, and if the parents didn’t sign it, this was deemed as giving consent. In 2009, a law was passed requiring that consent be “active,” said McKeon. Since then, SAMHSA grantees have been required to make sure consent was active, he said.

In general, there is always a tension between the rights of individual families and the way the school interacts with children’s health, said Cathy Cowan, spokeswoman for the National Association of School Psychologists. “But as we learned with eye screenings and all kinds of other screenings, because the pediatric worlds can’t do everything, it’s important to screen for things that can be commonplace,” she said, adding that depression is “more common than people like to think.” Another reason for schools to be concerned about mental health problems is academics, said Cowan. “If you are not meeting the needs as a school community of the whole child, the child isn’t going to do his best in school,” she said.

“This association’s message and the profession’s message is that we should not be eliminating resources,” said Cowan. “TeenScreen is the most consistently recognized screening program designed for schools, to be used in schools.”

Face-to-face screen

And SAMHSA’s McKeon added that he doesn’t understand why parents would not want to know if their child had problems. “If one of my daughters was thinking of suicide, I would be very grateful to receive that information,” he said. But what if the screening was a false-positive — if the child doesn’t really have any risks? “That’s the trade-off,” said McKeon. “In any screening program, you have to choose between sensitivity and specificity.”

But for TeenScreen, there was a second level of screening, so that anyone who screened positive on the first screen would have a second face-to-face screening. “My understanding is that the second-level screen was not done by anyone from Columbia, but was the responsibility of the people implementing the program,” he said. “Either school personnel, like a psychologist or a guidance counselor, or a local community mental health center might do the second screen.”

Controversies

The 2004 New Freedom Commission under President Bush launched TeenScreen and brought in the Texas Medication Algorithm Project (TMAP), which originally started in the 1990s as a way to make mental healthcare more standardized. But because of funding from pharmaceutical companies that affected the drugs that were chosen, irregularities surfaced, and ultimately a whistleblower lawsuit led the Texas attorney general to sue Janssen (maker of Risperdal), saying the company secretly funded the TMAP. The Children’s Medication Algorithm Project (CMAP) was put on hold in 2008 because of those same concerns.

The other TeenScreen problem was an investigation into many different associations’ pharmaceutical funding, including TeenScreen’s, by Sen. Chuck Grassley two years ago. Columbia University responded that TeenScreen itself received no pharmaceutical funding, but did detail the connection of its two directors, who were not employees of the university, the response stressed. This summer, both of those directors, one of whom was Laurie Flynn, formerly of NAMI, resigned.

Correction: In this article on TeenScreen’s demise (published in MHW, December 11), the correct number of suicide prevention grantees using TeenScreen is 12 (out of a total of 135). In addition, SAMHSA has required its grantees to make sure parental consent was active since the start of the program in 2005. Finally, “some,” not “most” of the Garrett Lee Smith Memorial Act funding went to TeenScreen. We regret the errors. [12/17/12]