Is there room in our classrooms for what health experts argue is the most important of all tests? One that might tell a parent that a child is depressed, maybe suicidal?
Those tests are being given now in Clark County. The answers students give are considered indicators of a problem, not hard evidence. But health professionals - and even students - say the tests could be invaluable.
Mark Johnson, a junior at Green Valley High School, said while he considers himself well adjusted, some of his peers may be struggling. If a questionnaire could direct them to help, he said it's worth inconveniencing him with filling out yet another form.
"There's probably people walking around our school depressed every day, and I don't even know it," he said. "They may not even know they have a problem."
To some advocates, it's no different than checking a child's eyesight with a wall chart in the nurse's office, or demanding a student athlete have a physical exam before football tryouts.
But some critics wonder whether the questionnaire crosses the line. Are schools responsible for teaching teenagers how to drive? How to not get pregnant?
How about whether schools should identify which children are quietly suffocating in depression?
Joe Enge, a Nevada teacher since 1988, doesn't think that's a school's business.
Screening teenagers in school for mental health problems can backfire, he says. What if a healthy student is misidentified as at risk of suicide, wrongly stigmatized as mentally ill? What then?
That's why schools have no business allowing students to be asked questions about their mental health.
And that's his argument - even as Clark County is about to expand - to double - the number of schools that do just that.
Clark County is the largest district in the nation that subscribes to Columbia TeenScreen, which uses questionnaires as the first step toward evaluating an adolescent's mental health.
Parents must give permission for their children to participate in mental health screening, which was administered to ninth graders in Clark County last year. Questions include, "How often have you felt sad or depressed? Have you often felt grouchy or irritable? Have you thought seriously about killing yourself?"
The Clark County School District allowed the screening in 10 high schools last year as part of a pilot study. With a $1.2 million federal grant, the number of participating schools will double this year.
Nevada has one of the nation's highest rates of suicide for young adults. Of high schoolers who took part in a statewide survey, 16 percent said they had seriously considered killing themselves.
But Enge, chairman of the activist group EdWatch Nevada, said mental health screenings don't work for teenagers. He is particularly opposed to the TeenScreen program , which was developed by Columbia University.
"Schools should be in the business of educating our children instead of probing each for unscientific mental disorders that will lead to false diagnoses," Enge wrote to the State Board of Education about a week ago.
The false diagnoses will lead to a lifetime stigma and "treatment with dangerous and ineffective psychiatric medications," Enge said.
Education and health officials say the criticism is misguided. Gary Waters, a member of the state Board of Education, said the purpose of the screenings is to identify students who may be floundering emotionally.
"This is a catch-and-release program - it's not about diagnosis or treatment," said Waters, a licensed therapist who holds a master's degree in social work. "Participation is voluntary, and it's entirely up to parents whether or not they choose to act on the information we provide them."
Parents are provided with a list of social services that offer counseling and clinical intervention, but the TeenScreen program does not provide services beyond the initial questionnaire and follow-up interviews.
In the 2005-06 academic year, 7,743 freshmen at 10 high schools were screened with parental approval, an 84 percent participation rate. Of the students screened, 621 came up "positive," indicating a possible need for mental health services, and were assessed individually. Of those students, 357 were recommended for further mental health services.
Of the 219 parents surveyed after their child took part in the screening, all but 45 said they appreciated the heads-up. Of the parents who declined to give permission for the screening, the majority said they did not believe their child needed the service, or their child did not want to participate.
Dylan Frantz, a senior at Boulder City High School, said he doubted he would have taken the questionnaire seriously as a freshman. But he had no problem with screening students, provided the results weren't shared with classroom teachers.
"If kids think their teacher's going to give them special attention, they're not going to answer honestly," Frantz said. "But maybe if you actually need help, this way you could get it."
Nevada is one of 12 states to receive the nation's first-ever suicide prevention grants. They received bipartisan support in Congress, and infuriated conservative groups like the Rutherford Institute and the Eagle Forum.
Columbia TeenScreen says it has no ties to pharmaceutical companies, one of the chief rallying cries of its detractors. (Several years ago a Tennessee agency took a $7,500 donation from industry giant Eli Lilly to pay for screenings, something that's no longer allowed by the national program.)
Enge, a fellow with the Nevada Policy Research Institute, filed a complaint with the state ethics commission against the Board of Education, claiming TeenScreen exceeds the limits of the state's standards for health curriculum.
"If a kid has problems, a teacher knows the kid best and can refer them to a counselor where, with the parent's consent, something can be done," said Enge, who has most recently taught at Carson City High School.
Robert Butterworth, a Los Angeles-based child psychologist who specializes in adolescent trauma, disagreed.
"Teachers see 40 kids in one class, five times a day. We can't expect them to catch every warning sign, or even to know what all of them are," said Butterworth, whose wife teaches in public school. "With depression there can be problems sleeping, low energy and loss of appetite - all things that show up long after the school day's over."
And sometimes there are no outward signs of trouble, which is what makes screenings even more valuable, mental health experts say.
"When a kid kills themselves, the parents say, 'We had no idea,' " Butterworth said.
Bruce Johnson, who has three daughters in addition to son Ryan, said he would probably support screenings, provided the information was not used by the district to label or stigmatize students.
He questioned whether the results were going to the right people.
"Some of these kids are troubled because of an unhappy home life," Johnson said. "You're giving the results to parents who may be the source of the problems and saying, 'Fix it.' "
Enge says at best programs like TeenScreen are intrusive, and at worst, inaccurate.
They cite a study several years ago that quoted David Shaffer, the Columbia researcher who developed the program's questionnaire, as saying it incorrectly identified teens as suicidal 84 percent of the time.
"There's no way you can test for suicide, particularly with teenagers," Enge said. "It's the end of the world one day when they break up with a boyfriend, and they're on top of the world the next day."
While a high percentage of students might erroneously be flagged as having suicidal tendencies, the screening is designed to catch warning signs of other disorders as well, said Leslie McGuire, executive director of Columbia TeenScreen. When the screening results are expanded to include depression and drug abuse, the "false positive" rate drops to 19 percent. That means in 81 percent of the cases, warnings that showed up in the student's written questionnaire bore out in follow-up interviews with counselors.
"This is not just about suicide prevention, it's a broad mental health checkup," McGuire said. "We give kids a voluntary, safe and confidential way to talk about these things, and then connect their parents with someone who can help them."
Butterworth said the success and failure rates are beside the point.
"Even if it's a low number, isn't it worth it?" Butterworth said. "The alternative is doing nothing, and how many children has that helped?"
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