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They Treat Real Patients:
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  NCMHPC

National Coalition of Mental Health Professionals and Consumers, Inc.


an educational foundation and advocacy organization serving mental health consumers and professionals

 

StepOne for Parents and the Politics of Good Intentions

 by Michaele P. Dunlap, Psy.D.

September 2, 2005

Screening, as means to identify health problems in the general population has been promoted for decades. Think of eye exams in schools, mammograms, colonoscopies, regular dental check-ups.  We each are encouraged to check problems that may need to be addressed in our health. Screening for mental health problems in children and adolescents is a topic that has generated substantial controversy since publication of the New Freedom Commission’s final report in April 2003.  Amid charges that the project to screen children in schools is Orwellian, driven by the interests of drug companies and supported by school districts bent on invading the lives of families and drugging their children,  people in communities all over the country ( see: Iowa, Indiana, Florida, Illinois ) responded with distress to the use of the TeenScreen tool. There were legislative and school district moves in Illinois, Michigan, and Florida to make the use of such instruments mandatory, moves that met considerable resistance from citizens and privacy rights advocates.

The National Coalition’s Board of Directors is pleased to endorse an instrument for mental health screening created by Dr. Michael Conner, a psychologist in Oregon.  The screening instrument, StepOne for Parents maintains family privacy, parental control over information about their children and promises to move beyond controversy to provide a useful and effective means to bring families and adolescents to the clinical care they need.

StepOne for Parents (StepOne) is a computer-assisted mental health screening system available on the Internet. The system includes the Adolescent Clinical Screening Questionnaire (ACSQ) and subsequent clinical screening reports. The ACSQ is intended to involve, educate, and empower parents so they can seek help and services that they believe are appropriate and necessary for their children. StepOne has a “terms of use” agreement and qualifies a parent or other informant by testing the user’s knowledge after he or she reads the terms of use. People must pass a test of their understanding about the system to access it. This approach provides a means to measure informed consent. StepOne also qualifies parents as informants about the child by asking questions about their education, knowledge of their child, reading ability, and primary language.

To use StepOne for Parents go to http://www.InCrisis.org

Clinical screening reports (CSRs) are generated by the StepOne program. The reports are based on responses provided by parents who have been qualified by the system as reliable informants.  CSRs provide information in an organized format that can help parents seek help, communicate with school and health care professionals, and advocate for services they believe are appropriate and necessary.

In addition to qualifying the users, StepOne is designed to protect family privacy and to provide parents with information and initial guidance. StepOne does not replace the role of parents or the role of health care professionals. StepOne is designed to involve and support parents in understanding their children and to respect parental responsibilities and right to privacy.

StepOne was constructed to work online. The program can be used anywhere that parents have access to the Internet. This also allows the developers to update the system immediately. Parents can start the questionnaire, save their responses, and return later to finish. StepOne can collect information about the process and outcome of mental health interventions if the parent and informants return to their private file and provide a new screening. The system compares the first screening to the second and offers analysis of the differences.

The StepOne computer software provides a level of encryption and data security that is one of the highest available to the public. Services offered have been reviewed by a multidisciplinary team of health and education professionals. The system, in all levels of its operation, meets or exceeds ethical and professional standards for development and operation of an Internet mental health screening system.

StepOne is simple and easy to use. No appointment, oversight, third-party approval, or government involvement is necessary. Parents set up a secure personal account and are asked to complete a series of questionnaires about their children’s current and past behavior, especially behavior during the past 4 weeks.

StepOne asks many questions. Their purpose is both to create a screening report and to educate. Parents who use StepOne discover how well they know their children through questions they may never before have considered. Parents who answer "Don't Know" many times are advised to talk with their children or have a mental health professional talk with their children about relevant issues.

StepOne is designed to take input from two informants. When two parents complete the questionnaire, they may discover how much they agree or disagree about their child’s behavior and history. Parents are exposed to a broad range of questions, not only to identify potential problems but also to raise their awareness of potential problems. The process of parents getting to know their children’s feelings and situation better can be a positive step for families. Discussion between parents about their child’s mental and emotional well-being is an important part of parenting and, in itself, can help children.

The ACSQ can be used to identify symptoms and signs of behavioral problems, syndromes, and mental health disorders. It can be used to obtain historical and behavioral observations, ratings over time, and information from multiple sources and thus indicate the presence or absence of symptoms and disorders. Additionally, the system can measure a child’s probable response to an intervention, treatment, or program.

StepOne supports but does not replace the role of clinical interviews, functional evaluations, professional diagnosis, and the creation of treatment plans. InCrisis clinical screening reports utilize research principles that demonstrate ways reliable, accurate, and valid data can produce useful information for parents and school and health care professionals.

TeenScreen is a computer rather than Internet based screening method and requires the involvement of a motivated teenager.  It has utility for situations where adolescents want to have their problems paid attention to and their parents are not interested or involved.  TeenScreen is lauded in the New Freedom Commission report as an example of how things should be done. TeenScreen is a good tool if it is used ethically and professionally; it can compliment StepOne for Parents. TeenScreen has been in development at Columbia University for more than a decade, and as a consequence does not have the flexibility and multidimensional capability of Dr. Conner’s Internet based approach to mental health screening. Further, the politics of good intentions, i.e. the intent to promote means of mental health screening has run into its strongest resistance on the matter of TeenScreen and who its supporters and funding sources may or may not be. 

There was much discussion in 2003-2004 of an objective of universal screening. A Teen Screen Newsletter, Fall 2003 listed 16 national organizations as endorsing universal screening, including the American Psychiatric Association and the School Social Work Association of America. Their website currently (09/02/05) lists 34 organizations as supporting mental health screening, which seems to be a somewhat modified position. 

Numbers of protests resulted from the implementation of TeenScreen protocols in the nation’s schools. Particularly parents were concerned by the use of passive consent, “a skimpy form with no warnings.” Parents who did not sign the form and return it were considered to have given permission.  Lawsuits have been filed and there are numerous voices of protest against mental health screening objectives set by local and federal initiatives.

January 4, 2005, Rep. Ron Paul introduced the Parental Consent Act of 2005  to prohibit the use of Federal funds for any universal or mandatory mental health screening program. A SAMHSA Background document (posted on the TeenScreen site) asserts: “There are no federal funds being used to support mandatory screening.  Legislation prohibiting the practice is unnecessary.” Clearly, the resistance to Federal support for screening has generated a counter-response. 

The SAMHSA background document asserts Families Are the Decision-Makers.  Parents and families are, and will always be, the first line of prevention and identification of health problems for their children – including emotional and behavioral problems.  Parents, in consultation with health care providers and other professionals, are and should remain, the ultimate decision-maker regarding the health and wellbeing of their children. Parents are usually the first to recognize early signs and risk factors for potential problems in children, and often request screening for a child because of their own concerns. Professionals including physicians and educators must respect and listen to parents so that any problems can be identified early and appropriate referrals for assessment and care can be made. Whenever mental health screening is conducted, parental consent must be obtained.  

StepOne for Parents moves beyond the controversy to support adolescents and their families. Parents screen the emotional health of their children, on their own schedule, in the privacy of their own homes. StepOne was developed from the awareness that:

  • There is a scarcity of qualified professionals to screen children for behavioral and mental health concerns.
  • Parents should not have to wait for a screening appointment if the need is urgent.
  • Parents can provide reliable and useful information about their child.
  • Parents should be involved, educated and empowered to find help for their children.
  • Parents should be in control of the information about their children’s lives.

StepOne for Parents is currently being used in research programs in Oregon school districts, treatment programs and clinical settings. The research is sponsored by Mentor Research Institute (www.mentorresearch.org) and InCrisis, LLC.  In the near future adolescents and their families will be seeking therapy in clinics and offices all over the country, carrying a StepOne for Parents screening report that is comprehensive and useful. 

 

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