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March 13, 2006

Mental health screening bill "ethically challenged"
Hottinger covertly adds mental health into SF2841

Calling the Minnesota Senate's preschool mental health screening bill "ethically challenged," EdWatch President Renee Doyle charged its author, Senator Hottinger (DFL-St. Peter), with trying to mislead the public. Doyle was responding to the passage of SF2841 out of the Senate Early Childhood Committee last Thursday.

"He describes his bill as Expanding screening to include socioemotional development screening," Doyle stated. "Sometime between Wednesday afternoon and Thursday afternoon, the Senator decided that, rather than support his own bill to add mental health screening into preschool developmental screening, he would deceive the public into thinking that mental health screening has been there all along and bypass the whole public debate."

SF2841 was first introduced in the Senate March 8th with clear language expanding preschool screening to include "socioemotional development screening." A new version of that bill appeared at the next day's hearing, however, with all references to adding socioemotional screening removed -- instead stating only the following:

"The social/emotional component of the developmental assessment must be completed using a social/emotional screening instrument approved by the commissioner of education, and consistent with the standards of the commissioners of heath and human services."

        The changed SF2841 passed with four Senators voting yes. Two members opposed it -- Sens. Wergin (R-Princeton) and Nienow (R-Cambridge).

        "It's a outrage," Doyle continued, "to use a slick political move that circumvents the entire process in order to insert government into a place that is clearly not its business -- the minds of our youngest children. Not a single reference to 'social/emotional' exists anywhere in state law. Those four Senators are apparently willing to deceive the public about what they're doing." The other three Senators voting yes were Sens.Pappas (DFL-St. Paul), Scheid (DFL-Brooklyn Park), and Sparks (DFL- Austin). Sens. Kierlin (R-Winona) and Kubly (DFL-Granite Falls) were absent. Sen. Kelley (DFL-Hopkins) and Scheid are co-authors.

"It's parents and the public at large who are...not being told that socioemotional means mental health."
         Dr. Karen Effrem, who testified against the bill, suggested that even the words "socioemotional screening" are misleading to the public. "Everyone at the hearing was discussing mental health screening for preschoolers," stated Effrem. "It's parents and the public at large who are being deliberately misinformed -- not being told that socioemotional means mental health."

        Last year's similar attempt to expand preschool screening was described as "Children's mental health screenings and assessments" (SF 1365 -- Sen. Tomassoni, DFL-Chisholm). This year, the words "mental health" were removed.

        "They are covertly adding mental health screening to what is required in the developmental assessment," Dr. Effrem continued. "This will limit parents' freedom to access alternative developmental assessments outside of the government system. Most pediatricians presently perform objective assessments of cognitive and physical milestones, such as when a child walked or began to talk. New legal requirements for mental health assessments in the already required developmental screening would force pediatricians and other doctors outside of the education establishment to include these subjective, non-scientific assessments in order to provide the 'equivalent' screening the law requires."

        Also providing testimony opposing SF 2841 were Tom Prichard, President of the Minnesota Family Council, and Dr. Willard Harley, a licensed psychologist who has overseen a network of 41 mental health clinics in Minnesota with over one hundred psychiatrists, psychologists, social workers and chemical dependency counselors. SF2841 will next move to the full Senate for a vote.

EXCERPTS FROM THE HEARING
-- Karen R. Effrem, M.D., Pediatrician

"Government sponsored and controlled universal mental health screening, no matter how sweetly wrapped in the fig leaf of parental consent, should never, ever be implemented. It is never, EVER, the proper role of government to set norms for, assess or intervene in the thoughts and emotions of free citizens, much less innocent, vulnerable, and still developing children. It is our thoughts and emotions that make each of us uniquely and individually human, and we use these thoughts and emotions to understand the world and maintain our inalienable right to liberty."

-- Sen. John Hottinger, author of SF2841

"There have been many claims that social/emotional screening is unreliable and subjective. 'Ages and Stages' is a Social/Emotional screening tool that has 93% validity and 91% reliability."

-- Willard F. Harley, Jr., Ph.D, Licensed Psychologist

"Your data is wrong. For one thing, the reliability can never be less than the validity."

-- Dr. Effrem

"Technical data for the 'Ages and Stages' questionnaire being promoted for this legislation admits that its overall positive predictive value is only 27%. That means that for every 27 children that are supposedly correctly identified by the admittedly subjective DSM or other impressionistic screening instruments, 73 are falsely told that something is wrong with them and referred for further evaluation. That is three times the rate of false positives to putative true positives and worse than a coin flip. Any other screening procedure with that large a false positive rate would be eliminated from consideration with hysterical laughter."

-- National Association for the Mentally ill (NAMI), an organization which has received tax dollars from the federal mental health agency to help implement the New Freedom Commissionís recommendations, including universal screening

"The President's New Freedom Commission on Mental Health recommended that quality screening occur in school... 21% of children have a diagnosable mental, emotional or behavioral disorder."

-- Sen. Betsy Wergin, member of the Senate Early Childhood Committee

"Just looking at that number -- 21% have a diagnosable disorder -- I think we are over-diagnosing and we are over-medicating our kids."

-- Dr. Harley

"Therapy is not benign. It can hurt people, especially misdiagnosed children. Only a small percentage of children have severe emotional problems that should be treated."

-- Dr. Effrem

"Even if psychosocial or educational programs were used instead of medications, Dr. Benedetto Vitiello, head of child psychiatry at the National Institutes of Mental Health said in 2002, 'Little research has been conducted to study the effectiveness of psychosocial interventions in young children, and the long-term risk-benefit ratio of psychosocial and pharmacologic treatments is basically unknown.' î

-- Sen. Sean Nienow,.member of the Senate Early Childhood Committee

Sen. Nienow persuasively argued that, while preschool screening is technically voluntary and districts make required statements that parents have the right to refuse to participate, the message to parents is confusing and contradictory. Parents seldom understand that it's voluntary, Nienow stated repeatedly. He distributed an example from a Parent Consent form that a parent received in the past week, which stated:

"The parent or guardian has the right to refuse participation for their child, in any component of the screening program, and still be eligible for any other component; however, Minnesota Law requires parents to have children screened before school entrance."

[Emphasis in the original.]

Sen. Hottinger dismissed Sen. Nienow's concerns.

For more information, link to these resources:

Infant mental health (11/23/05)
Myths and Facts Regarding Mental Health Screening Programs and Psychiatric Drug Treatment for Children (pdf)
Dangers of Universal Mental Health Screening, Briefing Book (Newly Updated)

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