Other ethical issues enter into screening considerations. Screening in the absence of available preventive or early treatment services is a formula for frustration and serves to heighten the potential for emotionally isolating the identified child. Accordingly, in the committee’s view, screening is warranted if follow-up intervention is available and accessible that could protect against risk factors becoming predictive factors. If follow-up intervention is not available, the community will have to weigh other potential benefits, such as community awareness and the potential leveraging of resources against the potential issues raised. The committee also concludes that in cases of individual- or group-level screening, all families should be able to make an informed choice about the participation of their child in screening activities, including being provided information on the goals, methods, and intended use of collected information. Ensuring that families are fully informed, however, is an enormous task.
Screening as a pathway to better mental health will succeed only if all the attendant ethical issues are managed transparently. The most important element of screening programs going forward may be education of the public concerning the benefits of screening, including avoidance of risks and the importance of early interventions.
Public acceptance of screening for risks or early emotional and behavioral problems also becomes a factor in arranging for reimbursement of screening efforts. Costs of newborn screening are borne by the state as the result of legislation. This is not the case for screening related to mental, emotional, and behavioral health. A recent expert forum convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) identified lack of reimbursement incentives for screening and preventive mental health services as one of seven primary mental health barriers (Kautz, Mauch, and Smith, 2008). Economic issues also play a role in decisions about school-based screening because of reimbursement constraints, tight budgets, and reduced staffing in many districts. The future of prevention screening rests in part on public policy decisions.
There should be agreed-on guidelines for whom to refer for assessment, prevention services, or treatment. Validated screening tools have cut points or thresholds for concern that would make a child eligible for preventive services or treatment. The first step, following a positive screen, should be the performance of a more detailed psychological assessment to verify the screening results and to determine the nature and the severity of the risk or emotional or behavioral problem. This may take the form of more extensive psychological testing or a psychiatric interview (Perrin and Stancin, 2002). Too often, delay or lack of availability of psychological or psychiatric consultation becomes a barrier for timely assessment and creation of an action plan for the child or adolescent. Lack of training and