Preventing Mental, Emotional, and Behavioral Disorders Among Young People Progress and Possibilities (2009) / Chapter Skim
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8 Screening for Prevention
8 Screening for Prevention
Pages 221-240
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From page 221... ...
; or at individuals based on their unique behaviors or biomarkers that may be prodromal features of mental, emotional, and behavioral (MEB) disorders (for indicated prevention efforts, e.g., screening for risk factors when a child's grades in school fall unexpectedly)
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From page 222... ...
The idea of screening for risk factors is considerably different than screening for specific disorders, as is carried out in newborn screening for metabolic disorders that need immediate treatment, such as phenylketonuria. Nevertheless, identification of elevated risks can guide public investments and mobilize communities to pursue needed resources to reduce these risks.
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From page 223... ...
For example, mental health screening targets both risk factors and early behaviors or biomarkers that predict MEB disorders. Table 8-1 presents a revised set of criteria that are likely to lead to successful prevention through screening at the individual level.
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From page 224... ...
The natural history of the disease The antecedent history of the disorder and its should be adequately understood. developmental link to target risk factors should be adequately described.
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From page 225... ...
Although the origins of most MEB disorders and problems are still incompletely understood, the temporal relationship between early behavioral phenotypes and DSM-IV diagnosable conditions has been documented extensively. There are valuable models of how antecedent risk factors relate to the onset of these disorders.
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From page 226... ...
. Alternatively, universal preventive interventions have been shown to have lasting impact on those with the highest levels of aggressive behavior early on (Kellam, Brown, et al., 2008)
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From page 227... ...
, a Medicaid program, has been used largely to promote developmental screening. For a number of reasons, the intent of the program to include behavioral screening has not been fully realized; the EPSDT screening tools in nearly half the states do not address behavioral health issues at all (Semansky, Koyanagi, and Vandivort-Warren, 2003)
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From page 228... ...
Many of the states also included an effort to identify and address systematic policy barriers, including clarifying or amending state Medicaid policies. In an effort to improve the identification of children at risk for or with social or emotional development delays, the ABCD II consortium states each identified standardized, validated screening tools and encouraged pediatric primary care providers to use them as a routine part of their regular delivery of care.
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From page 229... ...
It provides technical assistance to help implement practices and policies designed to increase the use of developmental screening tools as part of the standard practice of well-child care delivered by primary care providers. SOURCES: Pelletier and Abrams (2003)
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From page 230... ...
Thus, universal screening procedures, especially those involving multiple stages, must be brief, technically adequate, valid across racial, ethnic, and socioeconomic groups, and produce valued outcomes in order to be acceptable in educational environments. Moreover, they should be accompanied by appropriate safeguards to address and obviate concerns.
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From page 231... ...
, it is unclear if they have been fully implemented. Although numerous screening tools are available, there is no single, widely accepted easy-to-use instrument.
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From page 232... ...
6. There should be validated screening tools or interview techniques to identify risks or early symptoms.
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. Although race and ethnicity are often confounded with socioeconomic status, and socioeconomic status is the stronger predictor of MEB disorders, efforts to increase the cultural relevance, including the linguistic acceptability, of screening tools warrant attention.
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From page 234... ...
. There has been public and organized opposition to screening programs, such as Teen Screen, a national mental health and suicide risk screening program ( Lenzer, 2004)
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From page 235... ...
Validated screening tools have cut points or thresholds for concern that would make a child eligible for preventive services or treatment. The first step, following a positive screen, should be the performance of a more detailed psychological assessment to verify the screening results and to determine the nature and the severity of the risk or emotional or behavioral problem.
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From page 236... ...
Modifying these risk factors requires community action, which does not respond in a timely fashion to the needs of individual children. Interventions for populationwide risk factors often fall back on individually focused efforts that identify or build on protective factors, such as parental or other caregiver support in the home.
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From page 237... ...
Children in foster care, children of depressed or alcohol- or drug-dependent parents, incarcerated children, children with chronic health conditions, children exposed to trauma or violence, or runaway youth all are at heightened risk of emotional or behavioral disorders. In the foster care system, given the known elevated risk, all young people are typically screened or accessed for MEB disorders (Child Welfare League of America, 2007; Stahmer, Leslie, et al., 2005)
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From page 238... ...
. Many of these screening tools are designed to elicit information from parents rather than through clinician observation, requiring minimal staff time to administer.
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From page 239... ...
This screening level uses public health principles and may be particularly cost effective. Conclusion: Screening for community- and group-level risk factors as well as individual-level screening for symptoms is an important public health function.
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