Universal Screening for Behavior

Illinois Children’s Mental Health Partnership’s Second Annual School Mental

Health ConferenceJune 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 social-emotional 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%

“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: Poor outcomes associated with delaying intervention

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

Tier 1/Universal School-Wide Assessment

School-Wide Prevention Systems

SIMEO Tools: HSC-T, SD-T, EI-T

Check-in Check-out (CICO)

Individualized Check-in Check-out (CICO), Groups, & Mentoring

Brief Functional Behavior Assessment/Behavior Intervention Plan (FBA/BIP)

Complex or Multiple-domain FBA/BIP

Wraparound/RENEW

ODRs, Attendance, Tardies, Grades, DIBELS, etc.

Daily Progress Report (DPR) (Behavior and Academic Goals)

Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc.

Social/Academic Instructional Groups (SAIG)

Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model

Illinois PBIS Network, Revised April 2012Adapted from T. Scott, 2004

Tier 2/Secondary

Tier 3/Tertiary

Inte

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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

Teachers Rank Order then Select Top 3 Students

on Each Dimension (Externalizing &

Internalizing)

Teachers Rate Top 3 Students in Each Dimension (Externalizing & Internalizing) using either SSBD,

BASC-2/BESS, or other evidence-based instrument

Gate 1

Gate 2

Pass Gate 1

Pass Gate 2Tier 2

Intervention

(Multiple Gating Procedure Adapted from Walker & Severson, 1992)

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

Externalizers: Students regularly displaying at least ONE of the listed behaviors

Externalizers: Top three students regularly displaying at least ONE of the listed behaviors

ID # Race/ethnicity

STEP ONE STEP TWO

Teacher ranking form: InternalizersTeacher 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

Adapted from Walker and Severson, 1992

Internalizers: Students regularly displaying at least ONE of the listed behaviors

Internalizers: Top three students Regularly displaying at least ONE Of the listed behaviors

ID# Race/ethnicity

STEP ONE STEP TWO

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

2007-08 2008-09 2009-10 2010-110%1%2%3%4%5%6%7%8%9%

10%

010203040506070

18

30

45

61

Illinois PBIS Network Schools 2008-11

Internalizers ExternalizersTotal 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 instrumentUse 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 systemDetermine systematic process for using results

to inform interventionsPlan for sharing screening and progress

monitoring results with staff and families

Universal Screening: Illinois PBIS Network Current Screening Instruments

Screener Pros ConsSystematic 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)

• Normed for grades 1-6 • Dated norms (normed in 1990)• Normative sample skewed to

western U.S. region

BASC-2/BESS (Kamphaus & Reynolds, 2007)http://www.pearsonassessments.com

• 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)

Universal Screening: Illinois PBIS Network Additional Evidence-Based Screening Instruments

Screener Pros Cons

Strengths and Difficulties Questionnaire (SDQ; Goodman, 2001)http://www.sdqinfo.org

• Measures internalizing/externalizing behaviors

• Free• Option of completing pencil and paper, or

online version• Can be scored online• Technically sound: Large, representative

normative group

• 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, MAExecutive 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 lives1

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

• 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

1

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/press-releases/proactive-screening-more-effective-in-identifying-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?

1

•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

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 GuideKey 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. 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?

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 in-school 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 ExampleFourteen year-old Sara* was a freshman student at her high school in the suburbs. She appeared to be adjusting well to high-school - 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 ExampleShe 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.”

ResourcesColumbia TeenScreen National Center for Mental Health Checkups

www.teenscreen.orgResources for parents:

http://www.teenscreen.org/library/implementation-materials-fact-sheets/152-schools-a-communities-faqs-for-parents Resources for School Administrators:

http://www.teenscreen.org/library/implementation-materials-fact-sheets/schools-and-communities/faqs-school-admin

Screening for Mental health, Inc.www.mnetalhealthscreening.org

It Only Takes Onewww.itonlytakesone.org

For Teens:Reach Out - We Can Help Us

www.reachout.comErika’s Lighthouse

www.erikaslighthouse.org

Thank you!

Carol Gall, MA, Executive Directorcwoz@mhai.org ext.324

Katie Mason, LPC, Program Director of Public Education and Disaster Mental Healthkmason@mhai.org ext.322

Mental Health America of Illinois312-368-9070

www.mhai.org