Height, weight and mental health: Checkups for teens to evaluate mind and body

As a matter of routine, pediatricians listen to their patients’ heartbeats. They check their eyes, probe their ears and look for physical problems that might need medical attention.

Few, however, have made it standard practice to get a handle on their patients’ mental health. That’s changing, at a local and national level, as more pediatricians join a program to make mental health screenings part of their routine checkups for adolescents.

Leading the charge is TeenScreen National Center for Mental Health Checkups at Columbia University in New York. For the past year, TeenScreen has been working with Kaiser Permanente’s Southern Colorado office, Kaiser’s contractor for mental health services, and about two dozen area doctors on a pilot program to screen patients ages 11 to 17 years old for mental health problems.

The idea is to identify adolescents at risk for mental illness and suicide and refer them for treatment early on, before serious issues arise.

“Most of the youngsters who get screened will be just fine, but for the ones who do have problems, the sooner we find them, the more likely we are to prevent long-term disability or even tragedy,” said Laurie Flynn, executive director of TeenScreen.

Colorado, and Colorado Springs in particular, stand to benefit from an early mental health screening program because of suicide rates that are among the highest in the nation. One report a few years ago indicated Colorado Springs had the second highest suicide rate in the nation, with Las Vegas at No. 1. Statewide, suicide is the second leading cause of death for those 11 to 18.

“I think the data in the community, and the state, is impressive: Our teens are at risk of having problems,” said Dr. Karen Childs, a pediatrician with Mountain View Medical who has been participating in the TeenScreen pilot.

Dr. John Genrich, a pediatrician who recently shuttered his Colorado Springs practice, said physicians tend to concentrate on kids’ physical problems, and rarely integrate mental health care into their exams except on a cursory level.

“You ask routine questions: ‘How are things at home? What’s going on in school?’ And you get standard answers. You get a shoulder shrug or an ‘uh-huh,’” said Genrich, who has become TeenScreen Primary Care’s physician advisor on a national level, and has a part-time practice in Denver.

The screening program uses a 37-item questionnaire that patients can fill out in private. Genrich likes that it can detect issues that parents can’t or don’t see. Parents are brought into the process with the child’s permission, and almost all give it, Genrich said.

“A parent will listen with their mouth open and become tearful,” he said of screenings that point to problems. “The mom will say to the child, ‘Why didn’t you tell me about this?’ The teen will say, ‘Well, Mom, you never asked me.”

Genrich said he started using the screening about a year ago, and about 10 percent of his patients were red-flagged as having mental health issues.

“That was very surprising to me, and I began thinking about it: I’ve been in solo practice more than 30 years, and I thought about the number of teenagers I had missed over the years who might have had significant mental health problems, but I’d never inquired.”

TeenScreen has been advocating for mental health screenings for adolescents and teens since the 1990s. In 2003, TeenScreen launched a screening program at schools nationwide; eight schools in Pueblo are Colorado’s sole participants.

About two years ago, TeenScreen started looking into taking its screening program into medical settings, and last year, TeenScreen Primary Care got under way at several locations in the U.S., including Southern Colorado. The primary care program has about 400 participants, and Kaiser is planning to expand it in Colorado.

“In many ways, the physician’s office is the best setting,” Flynn said. “The idea that you would have a mental health checkup at the same time you’re getting your annual physical just makes sense.”

Any pediatrician can participate, but Genrich said it’s imperative to have a system in place for immediate referrals to a mental health professional. Kaiser has done that through its mental health partner, ValueOptions Behavioral Health, and set up a system for reimbursing doctors.

Janet Karnes, director of the Suicide Prevention Partnership of the Pikes Peak Region, welcomes the program, but said some parents won’t be able to afford mental health treatment if their child is red-flagged in a screening.

“There needs to be a lot of follow up, and we’re dealing with a lot of families who, because of the economy, don’t have insurance or can’t afford co-pays,” Karnes said.

Flynn acknowledged the financial obstacle for some people, but said it’s important to do what can be done now.

“If we don’t try, we can’t succeed, and if we don’t keep bringing needs to the attention of policymakers, we can’t hold them accountable for doing more.”

Health care reform will eventually take care of what TeenScreen is attempting, by requiring health plans to provide access to annual depression screenings for both adults and adolescents, Flynn said. But she said TeenScreen will continue with its program, because it offers outreach, education, tools and materials on screenings.

One Colorado Springs parent, Christy Parr, has embraced the effort. She and her husband have depression in their families, so she was happy to have her 11-year-old son fill out the questionnaire during his annual checkup with Childs. The results came back fine, but she hopes he’ll continue to be screened at future visits.

“As a parent, I definitely want to know if there’s something I missed that could be telling me that my child could be in trouble, because I’ve seen that kind of trouble lead to tragedy,” said Parr, who had a family friend commit suicide a few weeks ago. “The earlier you catch it, the easier it will be to treat it.”

Startling stats

• Nine percent of Colorado children ages 12 to 17 have an episode of major depression in a year’s time.

• Suicide is the second leading cause of death in Colorado for those ages 11 to 18.

• In 2005, Colorado had the ninth highest suicide rate in the nation for kids ages 11 to 18.

• In a 2005 survey of Colorado high school students, 25 percent said they had felt sad and hopeless in the past 12 months; 14 percent said they had thought seriously about suicide; 11 percent had made a plan for suicide; 7 percent had attempted suicide; 1 percent made a suicide attempt that required medical attention.

• The El Paso County Coroner’s Office has seen suicide victims as young as 9.

• As many as two in three depressed children are not diagnosed as having the illness by their primary care physicians, and don’t receive mental health care.

Source: TeenScreen Primary Care

To learn more about TeenScreen, go to www.teenscreen.org, or call 212-265-4453