Screening via TeenScreen is always a voluntary activity, requiring the consent of both teens and parents. All results are confidential and are not shared with teachers or included in academic records. "On average, close to 50 percent of families will give consent for screening," says TeenScreen director Leslie McGuire. About a third of kids test positive on the questionnaire, and roughly half of those get referred for further evaluation after the clinical interview.
Preliminary results suggest TeenScreen has positive effects. In one follow-up survey of parents whose children were identified by the program, 72 percent reported their child was doing very well or showed significant improvement after participating in TeenScreen and seeing a mental health professional.
The U.S. Surgeon General has highlighted screening as an effective means of youth suicide prevention. Furthermore, President Bush's New Freedom Commission on Mental Health has cited TeenScreen as a model screening program. In addition, New York State is planning on implementing a modified version of the program for 400,000 kids.
These accolades do not mean that TeenScreen is without critics. It has come under fire from observers who fear that it could lead to mandatory screening, notably Rep. Ron Paul (R-Tex.), a physician, who tried unsuccessfully in 2005 to block federal funds for screening. (Neither TeenScreen nor the New Freedom Commission on Mental Health endorse mandatory screening.)
Caine points out that there are other techniques for preventing suicide, including gatekeeper approaches in which teachers and others receive training to spot suicidal tendencies.
"We don't think screening is the only way to prevent suicide," McGuire counters. "When a community has the resources and interest to do more than screening, we very much support that."
Shaffer also notes that gatekeeper approaches have their own weaknesses, some of which stem from the fact that "visible manifestations of suicidality are very nonspecific. So they generally try and look for grades going down, or kids seeming more irritable, or losing friends. These are extremely common adolescent behaviors that sometimes can be indicative of an underlying depression, but by no means always."
One concern voiced by Marcia Angell, a senior lecturer at Harvard Medical School, was whether Shaffer or TeenScreen had financial ties to drug companies that make antidepressants. Shaffer stresses he has no ties to drug companies, and TeenScreen has never been affiliated with or funded by any pharmaceutical companies.
Caine wonders what screening programs do with all the kids with problems they turn up. Flynn explains that a key part of the development time TeenScreen spends at each site involves making connections with local mental health service providers and finding out ways to help families find financial support if needed. "We're not just identifying teens at risk and saying good luck to them," she notes.
Flynn's daughter Shannon is now 37. "She finished high school and got a graduate degree, and two years ago she got married. Nothing was easy, but it's a happy outcome," Flynn observes. "I shudder to think what the outcome might have been. It's why I'm so passionate about identifying risks early."