Summary

The use of screening reports could be controversial for some people who provide or deny services to families and children. This controversy may be the result of misunderstandings, or a failure on the part of a professional, school or program to examine and learn more about the purpose, validity, structure, safeguards, usefulness  and proper use of StepOne reports. In response to this potential issue, InCrisis is taking appropriate steps to proactively develop, operate, monitor, inform and improve services. InCrisis has taken steps to anticipate the impact of reports and to mitigate those concerns in good faith. InCrisis will continue to do so when offering new services and will address issues, as they surface, by providing program updates and publishing additional information on the InCrisis web site.

Developing and operating innovative services for education and health care should also involve an assessment and documentation of potential impacts. By documenting potential impacts on this website, InCrisis can invite consumer and professional feedback, monitor services, mitigate foreseeable concerns and manage future services. Documenting potential impacts is a professional and ethical activity. The following is a summary of potential impacts.

Impact on Families

StepOne reports are designed to help parents identify and respond to potential mental health problems as well as high risk behavior. The screening takes place wherever parents have access to the internet. This will most often be in the privacy of their own home. InCrisis technology uses the highest level of encryption available in the private sector. Data storage is at a higher level of security than medical records. While reasonable steps have been taken to maintain privacy, parents must exercise discretion regarding materials printed or presented on their computer screen. Parents are responsible for security of their password and results.

Information is gathered and documented in a manner that is understandable and useful to parents and qualified professionals. InCrisis information processing technology is designed to empower parents and professionals with the ability to conduct evaluations, advocate for health care services, locate appropriate service and monitor a child's behavior and progress. StepOne reports allow parents and professionals to estimate the benefit of services and the impact of no services. This can be done as needed, without appointment, and at minimal or no cost. This can be of tremendous benefit to parents who live in rural areas where mental health services are not available and are difficult to access. Parents who decide to seek help will be in a position to seek help that is appropriate to their level of need.

Use of StepOne reports are designed to place greater responsibility on parents while empowering them with information necessary to take initiative and to respond to potential problems and concerns. It is a parent's responsibility to raise healthy children who are socially responsible and safe. Parents cannot reliably expect schools, public health systems, physicians and law enforcement to identify and address signs of mental health and behavioral problems. Public agencies and primary health care services are currently not funded, nor is there evidence nationally that they will be staffed to provide the level of service necessary when potential problems are identified. For this reason, parents must become involved, educated and empower to seek care they believe is appropriate and necessary while feeling confident that their privacy is being respected.

Use of StepOne reports has produced a measurable impact of Families. A surprising number of parents agree on their child's behavior and history. Significant difference between parents are uncommon. However, a few parents may find they have significant disagreement regarding their child's history and behavior. This may be the result of poor communication or a lack of parental involvement in parenting. Tension may surface in some cases between parents who need to be more involved with their child and talk with each other in order to provide consistent and appropriate parenting. To this end, StepOne reports offer parents who are estranged, separated or divorced a means to share information and focus discussion regarding potential problems, prompting them to become more effectively involved

Responsibility for prevention, detection and early treatment can be shifted more to parents who will have a reliable means to help them examine behavior. By using StepOne reports, parents will need to realistically examine their expectations of law enforcement, health care and educational professionals. Information regarding these services are provided with each report. A more comprehensive view, rather than a focus on isolated behavior will likely result. To this end, many parents can expect to gain a greater awareness regarding the impact of mental health and substance abuse as well as family, school and social problems.

Parents who are researching prevention and intervention options may discover that there are no easy, simple, perfect or complete solutions. Many parents may come to realize that prevention and early detection would have been preferable to intervention and treatment (in hind-sight). Parents may also become more aware of the impact of ignoring problems, failure to recognize early signs and the consequences of their inability or delay in getting help.

There is no way to safeguard against people who ignore or willfully and intentionally misuse informational resources. A small number of parents may attempt to use StepOne reports in a way that ignores the Terms of Use and requirement for proper use that are outlined. A few  parents may try to trick or manipulate the system for reasons that are associated with personal problems, legal agendas, or possibly their own mental or addictive disorder. Parents may ignore and not seek consultation when further evaluation is recommended. Some parents will not be satisfied with their experience or the results of their questionnaires. They may encounter problems with the internet or software, or they will disagree with the level of risk or the potential problems that are identified.

Impact on Medical Service

There is little doubt that mental health and behavioral health are closely linked to physical health. In fact, the research is such that this link is common knowledge in the medical community. Despite this awareness, there is often a lack of structure in service delivery that allows physicians to screen, evaluate and respond effectively to mental health problems.

Health problems later in life are often related to issues that originated in childhood. Emotional struggles, interpersonal conflict and social problems affect behavior and choices. These problems can in turn affect health and well-being as children grow into adults. Early detection is recognized as important, yet physicians are almost never reimbursed for screening, treatment or referral for problems that are not deemed entirely physical in origin. The term "medical necessity" has been used to limit third party insurance reimbursements to physicians. Problems are not considered "medically necessary" if there is no objective or observable evidence of structural or pathophysiological problems.

The practice of medicine is patterned with routines and office structures that treat the consequences of illness and unhealthy behavior. Medical practices are not designed for early detection and prevention of contributing and co-morbid mental health problems. However, this may change as there is a growing national public health care agenda, evident in the executive and legislative government, to recognize the importance of early detection and treatment of mental and emotional problems in youth. But while concerns have been expressed by national leadership, parity between medical and mental health care services is not the norm. Funding for mental health is not an important or adequately funded agenda in the state and federal legislatures. No where is this more apparent than adolescent and children's mental health.

The full impact of StepOne reports on health care has yet to be seen. One likely impact is that parents will bring their child to see their family physician for a physical. Parents may do this in order to eliminate the existence of treatable medical conditions that may be impacting the mental and emotional status of their child. This includes acne, diet, exercise, diabetes, thyroid disorders, anemia, sexual activity, hearing problems, etc. In addition to a medical screening, physicians may also be called upon to provide health information and guidance to children and their parents and to make appropriate referrals to qualified mental health professionals. In some cases, after further evaluation, a physician may prescribe a psychotropic medication. In complex cases, physicians may need consultation with or make a referral to a psychiatrist or psychiatric mental health nurse practitioner. StepOne is designed to support referral and to provide referral information in areas participating in a screening program.

When physicians treat mental and emotional disorders, their primary treatment option will often be to offer antidepressants or an anxiolytic. In some cases, they may prescribe medication for bipolar disorders, attention deficits and disorders related to psychotic conditions. Evaluation and documentation to support this course of treatment is an expected and increasingly important standard of practice. Unfortunately, physicians often find they lack the time, materials or other means to support their treatment interventions. Prescriptions can be the result of a best guess or trial and error. This is one area where StepOne reports can help. StepOne reports can provide physicians with a substantially reliable and comprehensive means to conduct further evaluation of their patients and to make maximum use of their time.

There is a historical trend in which medical services avoid interaction with mental health services. Physicians are likely to encounter mental health problems for which referral to mental health professionals can be problematic. While physicians may refer to professionals in their community, there is a scarcity of qualified mental health professionals, and those that work with adolescents may not have room for new patients.

When referral is necessary, making an appropriate referral should be based on screening and face-to-face evaluation. A medical examination may be a necessary part of that referral. StepOne reports are designed to help physicians make more appropriate referrals.

Once a physician completes his or her evaluation, documentation is always important. Documentation and decisions based on screening, appropriate evaluation and other information is an excellent means to provide appropriate care and to manage the risk of future problems.

Impact on Mental Health Services

Mental health professionals have long recognized a relationship between mental health and physical health. More importantly, they have been proponents of early detection and intervention for emotional and behavioral problems before they become more severe and entrenched. StepOne reports provide mental health professionals with the means to identify children who are at-risk and those with serious problems. The reports also provide the means to document a child's history and behavior so as to complement evaluation services provided by qualified mental health professionals.

StepOne report documentation provides a useful means to begin initial counseling or therapy sessions with a focus or strategy. This initial focus can save time and actually help counselors and therapists develop and focus on a more positive relationship with patients. Knowing the potential problems and the severity of those problems will allow clinicians to approach each case in a more timely and strategic manner. Initial findings shows that StepOne may reduce the number of appointments by three.

During beta testing, InCrisis identified potential problems associated with emerging technology and traditional health care delivery methods. These are not new to any emerging technology. Foremost, a few professionals will misperceive the purpose and scope of StepOne reports. A small number of professionals will not taken the time to thoroughly examine available information related to the safeguards, development, operation and proper use of InCrisis services. A few did not read the report entirely including information prepared specifically for health and mental health professionals. As a direct result, several professionals incorrectly concluded that StepOne reports were in some way intended to replace or compete with mental health professionals. InCrisis services are designed to function as a resource to support existing services, provide appropriate outreach to underserved populations and to empower parents to actually seek out care from appropriate professionals including evaluation. StepOne reports will actually increase the efficiency in which parents find help. Reports generated in communities where StepOne is supported will provide community specific referral information. Professionals are more likely to receive and take appropriate referrals for evaluation and treatment.

As with the medical community, mental health professionals will in time discover that screening prior to the first appointment will actually help them evaluate and manage problems more quickly and effectively. Proper screening is an excellent means to manage the risk of errors.

StepOne reports are highly reliable and comprehensive. The comprehensive and reliable nature of these reports reduces bias and errors in omission. The validity of brief face-to-face clinical interviews has never been established as good. Interviews that are not comprehensive and thorough cannot produce valid results. By using StepOne reports, mental health professionals may increase the reliability, comprehensiveness and upper limit of the validity of their interviews and results.

Impact on Public Education

Many of the problems facing parents and their children are not the responsibility of the schools. Many emotional, addictive and behavioral problems cannot be identified, evaluated or managed by public school programs. Schools are able to offer physical screenings for such concerns as hearing and vision problems, but "emotional" and "behavioral" screening are far more complex, expensive, sensitive and invasive. Families may not be willing to share private information about their children to schools fearing their child might be labeled or discriminated against. They may also object or discourage their children from participation in mental health screening conducted by schools.

Early detection and intervention by responsible parents, before it affects learning, could reduce the need for special education services. Screening procedure can assist with this process. With early detection and intervention, schools can support children who may ultimately need special education services.

The public and media have expressed concerns about suicide and self-destructive behavior in schools, but more concern is expressed about the level and risk for violence in schools. StepOne reports are designed to help parents identify and take steps to reduce the risk of suicide and violence. Schools face a number of practical limitations in terms of assessing the risk for suicide and violence in their student population. School faculty, school counselors, psychologists and staff may not be in position to gather sufficient information about every child including their history and behavior inside and outside school. In fact, parents will have more information regarding their child's history and behavior and it is ultimately the parent's responsibility to keep their children safe and prevent their children from doing harm to others. StepOne reports provide parents with a private means to screen their child and to take action as they deem appropriate. These reports are designed to facilitate an opportunity for parents and schools to work together in order to help a child.

Schools are not designed or staffed to provide crisis intervention services. While schools must deal with problems that surface, they cannot be expected to provide routine crisis intervention or mental health services for families and entire communities. Schools are not intended to serve as a community or a public health program. Where community mental health services are lacking, by default, schools may be expected to deal with these issues. Running a qualified crisis intervention service is unrealistic for all but the most highly funded schools. StepOne reports have been designed to give schools a resource for parents so that parents can screen and identify youth at-risk.

Parents have rights and responsibilities. School systems should not assume parental roles and responsibilities, but instead, should involve, educate and empower parents to monitor their child's behavior and seek care that parents believe is appropriate. To support parents, schools can provide parents with information about a child's behavior and history at school. In most cases, parents should have more information about their child that would be necessary for screening. By empowering parents with a low cost, comprehensive and reliable screening alternative, StepOne reports encourage parents to obtain further evaluation and to manage any risk that is identified. In this way, schools can support parents and avoid proximity to services that should be provided by mental health professionals. It can be argued that schools that conduct screening incur responsibilities and obligations to manage the information they gather. Schools may wish to avoid roles that implicitly create an expectation on the part of parents that schools can offer, evaluate or manage mental health and behavioral problems.

The demand for special education services as well as evaluation services will  decrease over time as early detection and intervention reduces those needs. In some cases, StepOne reports may increase the number of requests for special education services or evaluation requests for eligibility. StepOne reports are not designed to make an eligibility determination, but they are designed to identify and raise issues that schools and mental health professionals can evaluate further.

StepOne reports provide information about special education services including various limitations, as well as advantages, and StepOne can provide initial guidance. Realistic expectations on the part of parents may actually reduce the risk for misunderstandings and conflict between parents and schools. However, InCrisis notes that the reports may also raise issues that may result in a conflict between parents and their child's school. Whether or not StepOne reports will increase or decrease the amount of conflict between parents and their schools will depend on the school, the community, the people involved and the unique problems facing individual parents. StepOne reports are designed to help reduce conflicts that may result from parents seeking services that may simply not be the responsibility of the school.

StepOne reports are designed to empower both parents and schools. StepOne design mitigates the disadvantages that parents face if they are required to anticipate and present information that schools need in order to initiate an eligibility process. At the same time, schools cannot make a valid determination if they are not provided with sufficient information. StepOne reports are designed to help reduce the risk of mistakes by empowering parents to obtain appropriate screening information and guidance on how to work more effectively with schools. Providing schools with a reliable screening report can empower parents and schools and help prevent misunderstandings and conflict.

StepOne reports may expose social and behavioral problems facing public education. Some of these will be related to school funding, lack of special education services and various social problems within a school. StepOne reports may also identify problems that may not be appropriate for schools to evaluate and manage.

Impact on Educational Consulting

Educational consultants are a private sector resource for parents who are seeking private education alternatives. In some cases, educational consulting will include private intervention programs for youth at-risk.

A qualified educational consultant has experience, training and licensure in mental health or education (or certification in educational planning). Educational placement and intervention invariably depends on an assessment of a child's behavior as well educational and mental health history. As a standard of care, an educational consultant should always conduct or obtain a screening before developing an education or intervention plan. In many cases, some type of behavioral or psychological evaluation will be needed.

StepOne reports are designed to support educational consultants in their screening process. StepOne reports do not replace the need for an educational consultant. Educational consultants can help parents determine if an intervention is necessary, identify programs, help with admissions, monitor the child's progress, advocate as necessary, plan further steps and provide families with other support. Historically, and until recently, many parents preferred to locate and place their child by working directly with a school or intervention program. This has become very difficult as there are many programs to consider and some who use confusing marketing tactics. When parents prefer to not use educational consultants, StepOne reports are designed to help parents, schools and programs recognize and properly evaluate potential issues that might otherwise be missed. This is important because there are many programs in the United States that admit children they cannot adequately serve, as well as children who would be better served in another program.

The decision to place a child in a boarding school and intervention program is an important and complex process that requires informed consent. This means that parents must be provided with information regarding their responsibilities, their rights and the risks involved. Parents must also be provided with enough information to have realistic expectations. InCrisis believes that informed consent can only be enhanced when parents are provided with a range of placement options, comprehensive screening results, as well as consultation and evaluation from a qualified educational consultant or mental health professional. To this end, StepOne reports are intended to bring parents and professionals together.

A few educational consultants, like a few mental health professionals, will incorrectly conclude that StepOne reports are replacing the role of consultants. This is not the intent or purpose. Among other purposes, StepOne reports are designed to help parents who may not know what an educational consultant is or how to locate one. Many parents, by virtue of their geographic location, do not have access to an educational consultant. These parents need support services and will not be served if professionals consider only the communities they serve. There is a tremendous scarcity of national educational consultants. In fact, many states have only a few educational consultants.

StepOne reports are designed to be used by parents, educational consultants and health care professionals. The information provided is intended to bring parents and appropriate professionals together. However, in some cases, StepOne reports may expose professionals who may be providing services beyond their experience, training or ability. There is a growing number of people in the U.S. who are offering educational consulting services and are doing so without training, licensure or certification.

There are other issues. There are probably only a few consultants and mental health professionals who refer to the same programs regardless of a child's needs. In some cases these consultants are compensated financially either directly or indirectly. Mutual referral arrangements that benefit programs and consultants is a growing practice nationally. Kickbacks and mutual referral relationships have introduced a bias into the referral process. There are also a few programs that offer a "finders fee" for a referral. A few consultants accept some form of "kickback" or compensation for a referral. These practices are controversial and are not condoned by many professional organizations as well as licensing boards. In fact, these practices are one reason why InCrisis recommends parents work with qualified educational consultants who are reputable members of the Independent Educational Consultant Association (IECA).

StepOne reports provides information about "standards of care", "standards of practice" as well as "ethical and professional services." InCrisis expects that consumer protection information efforts may upset a few consultants who provide questionable or outright unprofessional and unethical services to parents. Some may feel threatened and attempt to create controversy to defend their practices. InCrisis intends to make a good faith effort to identify and mitigate problems in a reasonable manner.

StepOne reports may identify private boarding schools and residential programs that are admitting children they are not qualified to work with. StepOne reports are designed to help parents and professionals make a determination on their own through education and information. This is an important activity because there are programs for youth at-risk that will accept almost any child regardless of the presenting problems. In some cases these admissions are intentional (ignoring important issues) and in other cases they are the result of negligence (failure to identify issues).

Conclusion

Parents are the solutions. Parents are only the problem when they are not involved, informed and empowered. Because parents have ultimate responsibility to care for their child, StepOne reports are designed to reduce the risk of erroneous decisions by providing comprehensive, meaningful and organized information about a child based on the parent's perspective.  StepOne reports are based on an premise that parents, and not just professionals, should be empowered to advocate and participate in the problem solving and decision making process. In effect, parents must have a "voice". To find the best solution, parents should be involved, informed and empowered to seek consultation with qualified professionals regarding education, treatment or intervention decisions affecting their children.