Children’s Social, Emotional & Behavioral Health Plan:
A Critique of the Problems in the Indiana
Children’s Social, Emotional & Behavioral Health Plan
Introduced 20 September 2006
As Required by: State Enrolled Act No. 529 / Indiana Code 20-19-5
By: Ed Sparks, Indianapolis, Indiana
1 October 2006
We, the citizens of Indiana, have a problem. The state is proposing to extend its powers deeply into every family in Indiana by introducing a “Mental Health Screening” plan that will affect every child in Indiana from birth to 22 years of age. Here is a bit of that plan.
On Wednesday, September 20, 2006 the Commission on Mental Health convened a public meeting at the Indiana State House to introduce, discuss and receive comments on the “Children’s Social, Emotional and Behavioral Health Plan”. In the 2005 Legislative session the General Assembly saw the need for a “comprehensive” children’s mental health plan and passed the Senate Enrolled Act 529, which includes a section regarding children’s mental health services. This legislation called for the State of Indiana to work in hand with the Department of Education to complete three tasks. From the Plan the points are:
Develop a Children’s Social, Emotional and Behavioral Health Plan, containing short-term and long-term recommendations to provide comprehensive, coordinated mental health prevention, early intervention, and treatment services for children from birth (0) through age 22;
Adopt joint rules under IC 4-22-2, concerning the children’s social, emotional, and
behavioral health plan; and
Conduct hearings on the implementation of the plan before adopting joint rules
under this chapter.
Deep into the Presentation (page 8) the Plan states:
“In Indiana it is estimated there are 857,854 youth aged 9-17 who have emotional difficulties; of these youth, 31,639 may be eligible for public mental health services (200% of federal poverty level); 79% of these youth are currently being served (May 2006). During the same time period, 6% of youth estimated to be in need of and eligible for public substance abuse treatment were receiving services[4].”
Although a superscript [4] is given for these figures no source documentation for them is provided in the document and I am unable to verify that statement. It is highly doubtful, and surely unreasonable even to assume, that 87% of the Indiana school students have emotional difficulties!
In that plan, on page 5, under main heading of “Expectations and Outcomes of the Plan”, (the first of seven areas of expectations) under the first subheading titled “Early Identification and Assessment” the Department of Education is instructed to accomplish three things. These are:
Participate in early identification initiatives (state agencies, community agencies, health care providers, child care providers, parents and schools).
Encourage parental involvement in noting early signs of possible need for assessment.
Establish one assessment for fair measurement of preliminary information needed to help a child and improve the child’s situation.
Each of these is very intrusive and would allow the department of education (through the government schools) to pry into any state organization to find information about its potential subjects. The third item is extremely important. This item directs the DOE to establish a single testing plan, a mental health screening test to apply to every child in Indiana. This testing is to apply to every child in Indiana whether that child is attending a government school, a private school or is home schooled. There is no exclusion for any child mentioned anywhere in this Plan or in the original authorization of Senate Enrolled Act No. 529 or Indiana Code 20-19-5.
This Plan defines a universal testing scheme that is designed to reach every child in Indiana. It assumes that it is the governments’ job to intervene in the social and emotional life of all Indiana children. This plan is designed to set the standards, monitor those standards and enforce those standards for every child beginning at birth and continuing until the person is 22 years of age.
Individual beliefs, personal ideals and the religion of the individual families are to be ignored; for the child is to be judged by the one standard set in place by the decisions of the Commission (that is, the State) and as detailed in the Plan.
On page 9 we see how the Plan will be extended to children that are not judged in dire need of mental health treatment, maybe even those without a proper diagnosis. Under a section titled “The Stigma Associated with Mental Illness is a Barrier” the Plan states:
“Needed services should be offered to the child despite the child’s label/eligibility category. It is recommended that service systems develop ways to offer services to children and families that are having difficulties but do not reach the level of a mental health diagnosis (e.g., interventions such as counseling, support groups, and skill-building classes).”
The Plan does not state whether these services will be provided on a voluntary basis or that the child will be required to accept those services that are to be made available to him. Remember, this section applies to children who are not judged to meet the legal eligibility for state supplied mental health services. Under SEA No. 529 the child has no recourse. He must accept the services from the State. Consider the implications of the following:
In testimony to the State of Georgia Senate, August 16, 2006, Dr. Fred A. Baughman, Jr. stated:
“Today, 91% of children who see a child psychiatrist are put on a drug, 18%--most of them normal—on a dangerous, deadly, antipsychotic. In 1960 when I graduated from the NYU School of Medicine, no such thing as a psychiatric disease existed.”
The Plan recommends extending its mental health services to youths who do not meet the minimum state standards for those services. This is a plan, instructed by the Legislature, to extend mental health screening services to all Indiana children. This is a plan being, unbelievably, mandated in a state where, in 2003, with 1,691,657 children between the ages of 0-18 years, only 20 children committed suicide. That is a rate of 1.18 per 100,000, a statistically insignificant number, though heartbreaking to the parents of those 20 children. The solution is certainly not to screen the other 1,691,637 children and have them wind up on psychiatric drugs that have FDA black box warnings that they can cause suicidal ideation!
In testimony to the Minnesota State Senate, March 9, 2006, Karen R. Effrem, MD stated:
“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.”
Well said! Government-controlled mental health screening should never be implemented. To see my thoughts on the future of government controlled schools see the Petition on my web site, www.edalert.com. In it I call for government schools to be converted to private schools as New Zealand did a few years ago. (See the address by Maurice P. McTigue at Hillsdale College delivered on February 11, 2004 at http://www.hillsdale.edu/imprimis/2004/april_printable.htm)
Even the authors of the Plan have doubts about its effectiveness. On page 23 they state:
“The gap between science and practice includes limitations in the evidence base, implementation issues, and limited capacity for outcome based quality management. … Furthermore, some best practices may not have been studied and documented in the research literature.”
This paragraph (two lines were omitted) is where the authors of the Mental Health Screening Plan admit these methods have not been studied thoroughly enough and that there are uncertainties, dangers and ineffectiveness in applying them in psychological treatments to children. It is indeed scary when the basic document admits that:
“some best practices may not have been studied and documented in the research literature.”
And, with these admitted limitations, we are still expected to submit our children to this Mental “Health” Screening Plan…..?
Back to the Mental Health Screening Plan:
On page 30, under the section titled “Goals and Strategies” under the heading “Goal” and the subheading titled “Strategy 1” we see that the State is to:
“Provide parents and families with learning opportunities related to the importance of their children’s social and emotional development.”
Here the state sets the standard for the child’s belief and is set to force the parents and families to partake of these “learning” opportunities. The key word here is “importance” and this has many implications.
Who is to judge the “importance” of a child’s development? When I was in high school in Texas one of our teachers told one of my fellow students that he would never amount to anything. That boy went on to become an assistant attorney general of Texas and led the investigation that brought down the governor of Texas. Every one of those school children is important, no matter what their social or financial status, and we must never let the government, in any way, affect or interfere with the normal development of those children. Under the Mental Health Screening Plan there is no exclusion or way out of this mandatory screening procedure. (See below.)
Under the same heading on the same page, (page 30), “Strategy 5” states:
“Assure earlier identification and intervention of mental health disorders in infants and toddlers and young children by providing practitioners with mental health consultation and training to increase their capacity to identify and assist families with infants and young children whose behavior has begun to deviate from the normal range of development.”
Here the state instructs the school to define the “normal” range of development and to enforce those standards. In short, if the family believes in freedom, the right of free speech, the right to private property and the pursuit of happiness and should the government decide those are abnormal, the family will be “trained” and not allowed to teach those values to the infants and toddlers and young children within that family. Under this Plan the state owns the child.
The 1999 Surgeon General’s Report on Mental Health, page 7, states:
“The science is challenging because of the ongoing process of development. The normally developing child hardly stays the same long enough to make stable measurements. Adult criteria for illness can be difficult to apply to children and adolescents, when the signs and symptoms of mental disorders are often also the characteristics of normal development.”
Yet the Plan says it wants to assure earlier identification and intervention in families with infants and young children while the Surgeon General says that those “disorders” may just be normal development. In this conflict of opinions I would go with the Surgeon General.
Back to the Plan: On page 31, under “Goals” the schools are instructed to:
“Schools: Incorporate the social and emotional development of children as an integral component to the mission of schools, critical to the development of the whole child, and necessary to academic readiness and school success.”
Here we see the State instructing the schools to incorporate the beliefs behind the screening test as a part of the education of the child. It then ties those beliefs and that testing to the schools judgment of the child’s academic qualifications for eventual graduation grading or “school success”.
This is an attempt by the state, as represented here by the Commission, to control minds and reduce challenges from the public. In these five “Strategies” we see explicit instructions to train parents and families, mental health providers, health care service providers, social service agencies “with mental health consultation and training to increase their capacity to identify and assist families with infants and young children whose behavior has begun to deviate from the normal range of development”. (Strategy 5, page 30.) Poorly-trained school personnel are to do the testing and evaluation. This is unacceptable. We must never trust our children to improperly trained medical personnel.
The state is thus assigning to itself the right to define the normal “range of development” and to train everyone (it deems acceptable) to judge children and infants behavior, and to work to correct deviant activities or thoughts within those children.
In this same section, “Goals and Strategies” still under the “Goal” subheading, on page 31, the introduction for the subheading “SCHOOLS” states:
“Incorporate the social and emotional development of children as an integral component to the mission of schools, critical to the development of the whole child, and necessary to academic readiness and school success.”
With this statement we see the ultimate state instruction to the government schools. The “state defined” social and emotional development of the children is to be incorporated into the daily education of the child, as an “integral component” within the structure of the daily instructions available and presented to the school children.
The family expects the school to deliver an Academic education, that is, reading, writing and arithmetic, to the child, yet here we see that those basic Academic studies are subordinated to the social and emotional development of the whole child.
In this same section, page 31, “Goals”: Strategy 3 states:
“Maximize Medicaid funding for schools.”
This little statement opens a whole new discourse. My first question is simple. Why do the schools need Medicaid funding? Medicaid is a state-financed health plan for individuals who have fallen below certain income standards and is available to them as an aid for their help to return to a productive part of society. It is not designed to be used as funding for schools.
Under the same section, “Goals”: Strategy 13 states:
“Develop and support a common language.”
Why would this Plan support a new common language? The language of this country is English and this nation decided back in the 1780’s that our language would be English. We certainly do not need another language in this country. Is this Orwell’s “Newspeak”?
We see that the Commission has made a dangerous assumption. The assumption throughout the Plan is that the State has the right to set the basic mental norms for its citizens and the right to enforce those norms via a system of policing that is based in the government schools. The State’s definition and enforcement of “mental norms” is to reach into every home and touch infants as young as 4 months of age--or younger. The SEA No 529 says from birth to twenty-two (22) years of age. Again there is no positive, parental initiated, way out. (See below.) There are no exemptions.
On page 33 under “Schools” we see:
“It is important for schools to incorporate the social and emotional development of children as an integral component to their mission. Social and emotional development is critical to the development of the whole child and necessary to academic readiness and school success.
Here the State is setting the standards for social and emotional development and enforcing those standards through the sword it wields known as school success. If the child does not conform to those “state defined social and emotional” standards the child will not be judged as successful in school and will not graduate. The State is here seen to be donning the mailed gloves.
Under the section titled “Training and Curriculum”, page 33 of the Plan, we find:
“In Indiana, it is important to ensure development and implementation of a plan to incorporate social emotional learning standards as part of the Indiana Academic Standards.”
Again, the State with no input from its clients, the citizens of the State, has set and defined the “normal” social emotional learning standards and insists that those standards become a part of the standard curriculum taught in every state school. Under these standards there is no way out (see below) for the family who does not wish to participate in the State defined “normal emotional learning standards”.
Parental Permission:
Parental permission is addressed on Page 10 and Page 11 of the Plan. It states:
Page 10: “Screening must be voluntary, active parental consent must be obtained, and clear procedures must be in place for notifying parents of the screening.”
Page 11: “Parental involvement and approval is essential in the screening, assessment, and treatment processes.”
This subject is again visited on page 63 in Appendix F and Titled “Glossary”. It states:
“Active Parental Consent – The term “active parental consent” means collecting a signature and/or permission from the parent or guardian of each child authorizing an agency to give the child a screening or assessment.”
These statements are nothing more than a placebo. They are placed in the Plan to nullify parental resistance and eliminate any negative feeling toward such an invasive plan as this. Screening plans in other states had the same wording and assurance that the parental consent would always be sought before the testing was accomplished. When few permission slips were returned those giving the tests simply changed the rules. They then judged that if the permission slip was not returned (Passive Consent) then approval was assumed and the screening for each child was then accomplished. There is no legal requirement that the parental approval be received before the testing is accomplished and no requirement to prevent the schools from changing the approval process. (See the Protection of Pupil Rights Amendment, a federal law that requires written parental consent on any psychological screening. http://ed.gov/policy/gen/guid/fpco/ppra/index.htnl)
We must remember that the Plan supposedly does not require every student to participate in the mental health screening program. However, the law that set the Commission in place does require that mental health screening be given to every student from birth through twenty-two (22) years of age. Already, here in Indiana there is one lawsuit against the state for testing a student without parental notification or permission.
The Law: Senate Enrolled Act No. 529 / IC-20-19-5
The Requirements as stated under IC-20-19-5 are:
(5) “That social, emotional, and mental health screening be included as a part of routine examinations in schools and by health care providers;”
Mental health screening does not fall under the same general heading of eye or hearing testing that are now simply routine testing procedures. Mental health screening is a medical procedure and is a far more complicated testing procedure than testing a child’s eyesight or hearing. In most instances it requires a decision by a highly trained professional. (Note: Mental health screening is not a medical procedure at all. It relies on subjective judgment as there are no scientific tests that confirm any mental disorder.) See the following quotes:
The Daily News of Los Angeles: June 25, 2006.
“Many people have been made to believe that these disorders are actual medical conditions based on chemical imbalances in the blood or brain. However, there is no scientific evidence to support this.”
The NATIONAL JOURNAL: May 20, 2006:
“Still medical science has no biological or chemical tests that can determine whether a person is depressed, suicidal, schizophrenic, or afflicted with another mental problem. “There is no laboratory test that establishes a specific diagnosis,” said Steven Sharfstein, the 2005 president of the Baltimore-based Sheppard Pratt health System who heads the 35,000 member American Psychiatric Association.”
New York Times: June 14, 2005:
“Psychiatrists have been searching for more than a century for some biological marker for mental disease, to little avail.” – Benedict Carey.
An Indiana Law Suit Has Been Filed
Here in Indiana the parents of one Indiana school girl, Michael and Teresa Rhoades, have filed suit against the state. Their child was screened without their permission. The Rhoades’ daughter is a straight “A” student and acts as a mentor for another child yet one afternoon she came home and asked her mother what two mental illnesses were. She had been tested and found to be suffering from two mental illnesses, “obsessive compulsive disorder (OCD) and “social anxiety diagnosis”. The test had asked if she ever did something over and over again. She answered “Yes” because she helps her mother with house cleaning every weekend. The second illness was diagnosed because the young girl indicated that she did not “party” much. She was not allowed to go out on school nights.
Although there is a law that is supposed to protect and help parents, the Protection of Pupil Rights Amendment (PPRA) this federal law was ignored. This federal law states that prior, written parental consent must be obtained before a child can be given a survey, analysis or evaluation. “Passive Consent” is an illegal and deceptive method used to bypass the requirement for parental permission. Obviously, this will increase the number of children screened
Should this mental health screening Plan be adopted here in Indiana there must be a system set in place so that any child’s parents can simply send the school a note stating that they wish to exempt their child from any mental health screening Plan. If the screening is then accomplished the school personnel would then be liable for extensive damages. Any child’s parents should be able to “Opt out” of the testing program without the dangers associated with the Plans “Opt in” requirement. (There should also be informed consent that lists out that there is no evidence that screening works! There should be none of this “mental health screening” in our schools in the first place.) See References, below.
Dangers in the Testing Program:
There are great on-going dangers in the testing program. This mental health screening program is set, by the enabling legislation, to become a yearly program. The student will face the dangers of being judged (to need psychiatric care) every year of his school life. Consider this: If each year 10% of the school children are judged to be in need of psychiatric care, in ten years every child will be in the program. This is not a one-time thing. It is an on-going repeat-it-every year testing program.
Conclusion:
This Children’s Social, Emotional & Behavioral Health Plan is a very dangerous plan. It extends State control into the Social and Emotional activities of every child from birth to twenty-two (22) years of age. It allows the State to define acceptable behavior and then select the testing (Teen Screen?) to identify that acceptable behavior and to judge when that measured behavior is deemed unacceptable. There are no alternatives available for the so-judged person or child. He is then pushed into medical, psychiatric, treatment.
Following are some of my specific objections to this Plan.
Parental Consent: While there is an attempt to provide parental control by requiring them to “Opt In” to the program we know that already in Indiana that option has been overthrown and at least one child has been given the screening test without parental permission. Therefore, if the Plan is adopted there must be a clear method whereby the parent can provide an independent notice to the school that his child or children will not be included in any State designated and defined Mental Health Screening program. This parental “Opt Out” must be legally enforceable and include severe punishment to any provider who administers these tests to children without explicit parental permission. (Already in force, the PPRA requires written parental consent for any mental screening.) This screening should not be in the schools in the first place.
An Inflexible Test Procedure: It is obvious from the Plan that this testing procedure is to be inflexible. It will be in the hands of an inadequately trained school or other designated staff. An ISTEP test is subject to more scrutiny than this testing procedure. Any test that is designed to measure a person’s mental competence must be honed and evaluated by many professionally trained persons otherwise it is a blunt, unusable object. (See above. This is a judgment call as no degree of “professional” opinion would still qualify as a proof of a verifiable and proven disorder. There is NO SCIENCE to it. See video here: http://www.cchr.org/uploads/video/no_science.wmv. )
Normal, mental testing and evaluation procedures requires many evaluation sessions between the patient (the school children) and the provider. All of these sessions should be attended by the children’s parents or guardian so that the child’s rights are rigorously protected and total privacy is maintained. The provider cannot be overwhelmed by the sheer number of children he is evaluating and judging. I see that a single provider could handle, or be in the evaluation stage, at one time no more than twenty patients. Here for the first time in this critique I use the word “patients”, for these children are indeed patients and must be treated as such.
Let us consider how many health service professionals will be needed in Indiana. I estimate there are about one million children in Indiana who would fall within the definitions of children who would be under the care of professionals. If each professional can successfully evaluate and care for only about 20 patients at a time, then something like fifty thousand (50,000) professional care-givers will be required to provide the defined services to the Indiana school children. (You do the math.)
3. Privacy: The Doctor/Patient Relationship.
What about the secrecy of the doctor-patient relationship?
In Indiana, only a licensed medical doctor may make a medical analysis and write prescription for any medical patient. This implies that the mental health screening program as envisioned by the Commission on Mental Health must be handled entirely by fully trained and licensed medical doctors. It must, therefore, also follow that all the medical records created by this program will remain the property of, and enjoy the full legal protection common in all doctor-patient relationships. All the documents created within this program will remain private and only accessible between the doctor, his staff and the under-age patient and the under-age patient’s parents. No information will be given or supplied to outside consultants or other people who might have an interest other than medical involvement with the under-age patient. The records would not be available to, nor supplied to, any government agency in any form or format. These records must never be allowed to become a part of the students’ educational record, his personal history record or his work record.
Nowhere in the Children’s Social, Emotional & Behavioral Health Plan do I find any mention of the Commissions intent to maintain the integrity of those documents and the doctor/patient relationship. I find no mention of the need to meet the State-imposed legal requirement to maintain the records produced during the doctor-patient relationship as inviolate and not accessible or available to parties outside that relationship. These needs must be clearly addressed, legally defined and guaranteed.
This mental health screening Plan, as written and titled the “Children’s Social, Emotional & Behavioral Health Plan”, is unacceptable, it should be trashed and SEA 529 should be immediately repealed.
The chairman of the United States Preventive Services Task Force, who is also the chief medical officer of the Colorado Department of Public Health and Environment, was quoted in the June 16, Washington Post: “the panel would reach the same conclusion today…Whether or not we like to admit it, there are no interventions that have no harms … There is weak evidence that screening can distinguish people who will commit suicide from those who will not…And screening inevitably leads to treating some people who do not need it. Such interventions have consequences beyond side effects from drugs or other treatments…Unnecessary care drives up the cost of insurance, causing some people to lose coverage altogether.”
A Response To: Indiana Commission on Mental Healt
