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GUIDE Lines
Computerized Screening Assesses Risk of Suicide in Youth
By
Lawrence Epp, Ed.D., L.C.P.C.
Suicidal ideation is common among youth who
live in impoverished urban communities. These
young people may see gun battles between
warring drug traffickers every night. They may
live with adults who are addicted to drugs or
who periodically sexually or physically abuse
them.
Early in my career, I worked with a truly
extraordinary pediatrician, Michelle Horlein,
who was completing her developmental
pediatrics residency at Johns Hopkins Hospital.
She administered to adolescents a
computerized risk assessment tool and found
that they were willing to reveal to the
computer program what they would not tell an
adult. Some of the adolescents were my clients
with whom I felt I had formed an open and
close relationship but they disclosed to the
computerized assessment program high-risk
behaviors that they would not dare to share
with me.
When I learned of Dr. Horlein's findings, I
discovered a dangerous assumption of my own: I
believed that adolescents tell their therapists
everything, whereas the truth may be that they
tell us only a fraction of what they feel inside.
The adult-adolescent therapeutic alliance is a
cross-cultural encounter riddled with as much
distrust and anxiety as any clash of two very
different human beings. The cultural rift is one
of vast generational difference. Some years
later, I learned that Columbia University was
experimenting with a computerized mental
health screening tool, TeenScreen, and had
discovered the same phenomenon --
adolescents would disclose to TeenScreen
suicidal thoughts and behaviors that they would
not discuss with the adults closest to them,
including, at times, their guidance counselor or
therapist.
Two years ago, I initiated TeenScreen at GUIDE
in one of our middle school mental health
programs. On a spare computer, I set up the
TeenScreen computerized assessment software.
It essentially works as a talking psychiatric
interview that produces a summary of the
child's risk factors for suicide and other mental
illnesses. After appropriate parental consent is
obtained, the adolescent is placed in front of
the TeenScreen-installed computer to complete
the interview, out of the clinician's view.
Soon, a child in the care of two perceptive and
seasoned school mental health professionals
was referred to me and revealed suicidal
thoughts to TeenScreen that he had not
disclosed to the clinicians working so closely
with him. The interface between an adolescent
and a computer screen creates an anonymity
that allows more honest disclosure by the
adolescent.
The computerized screening process removes
the shame of disclosing socially unacceptable
thoughts or symptoms. Clearly, today's youth
see the computer as a resource for connection
with others and not as a cold, impersonal
technology, as my generation of therapists
have. Computerized assessment may be the
next advancement in mental health screening,
and I think TeenScreen is leading the way with
this potentially life-saving new technology.
This article also appeared in the current edition of the NATIONAL COUNCIL MAGAZINE - A quarterly publication from the National
Council for Community Behavioral Healthcare, Issue 2, 2009, and is re-printed with permission.