Screenings prompt fears of false labels
PHOTO BY KAREN ELSHOUT Chelsea Rhoades and her mother, Teresa Rhoades, talk about the psychological test, TeenScreen, that her school, Penn High School, in Mishawaka, Indiana gave her along with the rest of the freshman class last December.
By Matthew Franck
St. Louis Post-Dispatch
Something about a classroom exercise last December didn't sit right with Chelsea Rhoades.
So after an otherwise typical day at Penn High School in Mishawaka, Ind., the sophomore did what many teens her age would do. She took her concerns to mom.
Nearly a year later, her simple disclosure is viewed by many as a symbolic first shot in an escalating battle between the rights of parents and the efforts to identify mentally ill and potentially suicidal teens.
Rhoades and her parents are plaintiffs in a suit against the TeenScreen program, a questionnaire developed by Columbia University to help detect the warning signs of mental illness. The program is administered to thousands of young people each year at hundreds of sites nationwide.
Those who champion the program say it has the potential to save lives, alerting adults to problems long before teens become a danger to themselves or others. They say the program respects the rights of parents.
But to critics such as the Rhoades family, TeenScreen is at the least an invasion of privacy. At worst, they say, the program is falsely tagging impressionable teens with disorders they may never have, potentially adding them to the ranks of millions of teens on antidepressant medications.
"There's a lot of kids that are getting labeled off a 10-minute test, " said Teresa Rhoades, Chelsea's mother.
The Rhoades family's campaign against TeenScreen, which occupies most of Teresa Rhoades' spare time, has consequences that reach far beyond their community near South Bend, Ind.
Their suit has led other TeenScreen sites, including one in St. Louis, to restructure the way they handle parental consent, probably reducing the number of students who will be screened. The backlash against TeenScreen also fits into a far larger political movement, one that may have reduced support from the federal government and states such as Illinois for widespread mental health screening of children.
Looking for problems
In recent years, TeenScreen has enjoyed a meteoric rise in popularity. Its success has been propelled by the endorsement of dozens of organizations such as the National Alliance for the Mentally Ill, not to mention federal and state commissions.
Most notably, TeenScreen was held up as a model by the New Freedom Commission, a panel commissioned by President George W. Bush to seek ways to improve access to mental health services.
Several states have passed their own mental health action plans, some singling out TeenScreen as a model.
TeenScreen administrators say the program is based on scientific research of teens who had committed suicide.
"This is not some kind of Cosmo (Magazine) quiz, " said Leslie McGuire, director of TeenScreen.
Of the more than 55,000 tested by TeenScreen last year, about 9,000, or 17 percent, were referred to a mental health professional for a more complete evaluation.TeenScreen's research suggests that three-fourths of those who showed warning signs for suicide had never been suspected of having problems.
David Shaffer, a Columbia University professor who created TeenScreen, has published a peer-reviewed study suggesting the screening program accurately zeroes in on kids at risk for suicide. What researchers have yet to determine is whether Teen Screen reduces the likelihood of suicide.
Critics say they doubt such a link could be made. They point to a review by a federal task force that found "no evidence that screening for suicide risk reduces suicide attempts." But McGuire said the federal report dealt with suicide screenings by primary care physicians, not with school-based screenings like TeenScreen.
Some people who challenge the validity of TeenScreen's questions say they could lead a healthy teen to be marked as depressed or suffering from anxiety.
For copyright reasons, TeenScreen does not release its questions. But a copy of a questionnaire was obtained by the Post-Dispatch.
Some of the questions ask "how much of a problem" teens have had with issues such as "feeling nervous or afraid, " or "getting along with your friends."
McGuire said the questions are often misunderstood by critics, who wrongly believe that most teens would provide answers that identify them as showing signs of mental illness. In truth, she said, the questionnaire is more complex, with no single answer being used to identify potential concerns.
Chelsea Rhoades said she worried while taking the test that she might be identified as having a problem simply because she disclosed that she's nervous in front of crowds. Who, she wondered, isn't? Exactly what Chelsea was told after her 10-minute screening is in dispute.
Chelsea said she was told by those administering the test that she had a panic disorder and obsessive compulsive disorder.
TeenScreen administrators won't comment on the suit. But McGuire said TeenScreen does not claim to diagnose mental illness; it merely identifies risk factors. Only through more thorough follow-up is a diagnosis made by a trained professional.
A copy of the results of Chelsea's TeenScreen test supplied by her mother appears to back up McGuire's assertion. The document does not diagnose disorders. Rather, it recommends a more thorough clinical evaluation, which the family has refused.
For Rhoades, the assessment was an affront to everything she knew about her daughter. "I don't see anything wrong with my child, " she said.
But the family's suit isn't chiefly about whether Chelsea exhibits the warning signs of anxiety disorders.
Rather, the Rhoadeses are suing because they claim they never knew Chelsea was going to be screened, much less gave their consent.
At the time that Chelsea took the test, her school relied on passive consent, meaning parents were supposed to get a letter informing them of the TeenScreenprogram. Parents who didn't approve the screening had to return a form. Otherwise, the screening could go forward, presuming the student also agreed to the test.
The Rhoadeses said they never saw such a form, and Chelsea said she never heard that she could opt out of the screening.
John Whitehead, lead attorney on the case for the legal advocacy group, the Rutherford Institute, said he's not out to destroy the TeenScreen program but merely to ensure that parents know their rights.
Changes in consent
The repercussions of the Rhoadeses' suit are already being felt in the Pattonville School District, the only site in Missouri where TeenScreen is offered.
Pattonville began using the program in earnest last year, when it introduced the screening as part of the school's freshman health class. Since then, more than 200 students have been tested, and several have been referred for mental health evaluation.
Jean Harmon, a crisis counselor at the school, said the program was administered last year without the least bit of controversy.
"I had very positive contact with parents, " she said.
But many parents might not have even known the program existed. Like the school in Indiana, Pattonville used passive consent last year, introducing the possibility that teens have been screened at the school even if a parent never saw a consent form.
Now the school has switched to active consent, meaning that teens will be screened only if their parents return a form.
Pattonville's approval of TeenScreen also wouldn't have drawn attention from parents. The issue never came before the Pattonville School Board; administrators say no approval was needed since TeenScreen fits within existing school counseling programs.
In other school districts across the country, school boards have often been met with resistance from parents and anti-psychiatry groups when they vote on whether to sign up with TeenScreen.
Critics of TeenScreen are eager to organize opposition to the program at Pattonville. Leading the charge nationally is Phyllis Schlafly, head of the Eagle Forum, based in Alton. She has written extensively against TeenScreen.
Other opposition comes from Scientologists, who oppose the program because their faith rejects all forms of psychiatric treatment.
"This is the most vicious thing to come down the pike, " said Roger Teagarden, head of the Citizens Commission on Human Rights of St. Louis, which is supported by the Church of Scientology.
Teagarden only recently discovered that TeenScreen is operating at Pattonville. He vows to drum up opposition among parents.
The attacks on TeenScreen have not dampened the popularity of the program. McGuire reports long waiting lists of schools interested in signing up. A recent federal suicide prevention act allows states to use grant money to fund TeenScreen programs.
But in recent months, there are signs that the backlash against TeenScreen may have diminished enthusiasm for mental health screening.
Recently, several federal agencies endorsed a new mental health action plan. Unlike the New Freedom Commission report of 2003, the new plan fails to single outTeenScreen as a national model. The action plan goes to great lengths to explain that the federal government supports screenings only with parental consent and objects to universal screening of schoolchildren.
Mark Weber, a spokesman for the Substance Abuse and Mental Health Services Administration, said universal screening was too controversial to include in federal policy.
Illinois, perhaps more than any other state, is familiar with the controversy that surrounds mental health screening. In 2003, a state-appointed commission issued a draft report calling for universal screening of children.
The report, by the Illinois Children's Mental Health Task Force, was almost immediately criticized as a violation of parental rights.
Karen Hayes, director of Concerned Women for America Illinois chapter, joined others in attacking the report on the Internet. She also toured Illinois to speak on mental health screening. Each time, she said, she was amazed at how deep passions ran.
"It seems like it hits a nerve, and people show up when this is the topic, " Hayes said.
Barbara Shaw, who heads the Illinois Children's Mental Health Task Force, said the criticism was led by a small group who did not take the time to understand the commission's recommendation. "Nothing we could say could seem to penetrate" the idea that we were proposing mandatory screening, Shaw said.
The Illinois commission's final report does not mention universal screening.
Teen gets help
Harmon, the crisis counselor at Pattonville, is baffled by the opposition to screening.
She particularly takes issue with the claim that TeenScreen is merely used to funnel teens to the mental health profession for medication. Of the kids screened at Pattonville last year, Harmon said, she doesn't know of a single one who is on medication as a result of being screened.
McGuire, the program's director at Columbia University, said no drug industry money has been spent on the national program.
Among the parents who are pleased with the Pattonville program is one mother who did not want to be identified for fear of disclosing personal details about her daughter.
The woman said her daughter increasingly was showing signs of intense stress in her life, at one point spending large portions of spare time asleep.
When her daughter was identified as needing help through TeenScreen, the woman eagerly sought the free counseling session. Her daughter's behavior almost immediately improved.
"She got a lot out of it, " the mother said.
Harmon said she's certain that as the school moves toward active consent, dozens of students who would have been screened last year will not be this year.
"I think it's really sad, " she said. "My experience here at Pattonville has only been positive."
In the past few weeks, only about 35 of 300 active consent forms have been returned. Harmon attributes the low response to the inconvenience of having to mail back a consent form.
So far, she said, no parents have called to complain or demand that the school pull the plug on the screening.
But opposition appears to be mounting, judging from an envelope that was recently slipped under her door. Inside were news clips about the Rhoadeses' suit.
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