1 Strategies, Screening and Systems of Care Matthew C. Aalsma, Ph.D. Section of Adolescent Medicine Indiana University School of Medicine LEAH/SAHC February 15, 2007

2 Mental Health Screening Introduction  Need for screening Case example  Screening for... Domestic/dating violence Substance use Depression Suicide Health behavior

3 Mental Health Screening Introduction  Settings include... School Community mental health Hospitals Juvenile justice Workplace Health fair

4 Mental Health Screening Barriers and Opportunities  Opponents Example of Garrett Lee Smith Memorial Act 2004 Privacy  Issues of consent and assent President’s New Freedom Commission on Mental Health 2003

5 Mental Health Screening I mplementation Three broad considerations for program development: 1.Context for screening 2.Context for assessment 3.Policy considerations

6 Mental Health Screening Context for Screening 1.Consider objectives  Fulfilling regulatory requirements  Example of juvenile justice  Improving staff decision making  Example of health clinic  Manage resources  Need for data!

7 Mental Health Screening Context for Screening 2.Practical and financial feasibility  Informant availability  Youth and/or parent  Expertise  Efficiency of administration  Financial cost for materials  Paper/pencil versus computer  Space requirements

8 Mental Health Screening Context for Assessment  Assessment for follow-up screening Professional consultation Specific versus general follow-up assessment

9 Mental Health Screening Policy Considerations 1.Policies about decisions on screening and assessment results  Responses  Research  Resources  Risk

10 Mental Health Screening Policy Considerations 2.Policies about screening and assessment personnel 3.Policies controlling the use of screening and assessment data

11 Mental Health Screening Implementation Summary  Planning, planning, planning  Coalitions – Bringing parties together  Funding!!!!  National resources

12 Mental Health Screening Example: Pennsylvania  Youth in the juvenile justice system have high rates of mental illness Estimates for community – about 20% Estimates for juvenile offenders – over 65%  Fifteen out of 23 juvenile detention centers in Pennsylvania  18,607 admissions received Massachusetts Youth Screening Instrument Version 2 (MAYSI-2)

13 Mental Health Screening Example: Indiana  Indiana State Bar Association – Civil Rights for Children Report Summer 2005  Marion County instituted mental health screening Spring 2006  Statewide pilot project funded through Indiana Criminal Justice Institute Summer 2006  Submitted 2 nd pilot grant to expand program

14 Mental Health Screening Tools  Columbia Health Screen (CHS) Suicide screener, 14 items, about 10 minutes  Diagnostic Predictive Scales (DPS) General mental health screener, 52 items, about 10 minutes  Massachusetts Youth Screening Instrument Version 2 (MAYSI-2) General mental health screener, 52 items, about 10 minutes

15 Mental Health Screening Resources  Uncovering an epidemic... NEJM  National screening program from Columbia University

16 Mental Health Screening Resources  Juvenile Law Center – description of Pennsylvania program  Mental Health Screening and Assessment in Juvenile Justice (2005) Edited by Grisson, T., Vincent, G. & Seagrave, D. 