Florida Seeks to Expand Ineffective Mental Health Screening in Schools

May 7, 2018

by Karen R. Effrem, MD


As discussed a few weeks ago in this space, the state of Texas is ramping up its school-based mental health screening and research using students as guinea pigs. And as predicted after the Parkland, Fla., school shooting and the ill-considered law passed there, the same effort is starting to happen in the Sunshine State.

The Florida Association of District School Superintendents (FADSS) held a conference to discuss how to expand school-based mental health that was attended by the state’s 67 superintendents as well as several legislators and agency heads.

Broward County Superintendent and FADSS president Robert Runcie led the meeting. Runcie was superintendent during the February 2018 shooting that occurred at Marjory Stoneman Douglas High School. Runcie and Broward County Sheriff Scott Israel are under intense scrutiny for ignoring or downplaying violent acts and threats by many students, including shooter Nikolas Cruz.

School officials ignored multiple felonious threats that Cruz made to various students, despite reports of them to those officials. Teachers and other school staff all over the country have noted how unsafe schools have become since the trend of not reporting school violence based on race and disability status — an approach pioneered in Broward County — spread nationwide under the Obama administration. Also, as previously reported, Cruz was well known to the mental health system, having been in an alternative school due to behavior problems; had been medicated for ADHD; and was being treated for depression, possibly with medication, at the time of his crimes.

The FADSS meeting, described as “unprecedented” and “historic,” focused on how to use the nearly $87 million for student mental health included in the Marjory Stoneman Douglas School Safety Act passed in March that includes:

…nearly $70 million in mental health assistance to the schools, $6.7 million for youth mental health awareness and training, and $9.8 million to the Department of Children and Families for additional Community Action Treatment Teams, an alternative to out-of-home placement for minors with serious behavioral health conditions.

As in the Texas situation, mental health data mining is a big deal. Superintendents from small, rural counties were told that in order to keep the money spigot open, the outcomes data for their mental health programs is “essential.” What the superintendents and legislators do not understand is how subjective and inaccurate mental health data and surveys that pull students into these programs — particularly screening and social emotional learning (SEL) surveys, as well as universal behavioral modification and outcome data — can be. We have previously discussed the Columbia Teen Screen survey that was only correct about 16 percent of time in accurately finding teens that actually had mental health issues requiring follow-up (called the Positive Predictive Value or PPV). Another review showed that only two of nine commonly used depression screening scales had a PPV at fifty percent, or no better than a coin flip.

This is very concerning on a host of levels:

  • The vast majority of students referred for follow-up and treatment by screening do not actually have a problem requiring treatment.
  • Following up on all of these false positive screenings will use up already scarce resources.
  • If long and well-trained experts admit that they are not able to predict who will become violent after following a already diagnosed patient for long time, how can some quick screen work given by an already over-worked teacher or staff person?

Even Education Week blogger Peter DeWitt, who generally believes SEL is very important to education, asked important questions about whether or not this really is the job of schools in one of his recent columns:

At the same time schools experience hardships that they don’t always control, they have a battle over whether they should be charged with teaching social-emotional learning (SEL). This pressure of teaching SEL comes on top of their primary job of being a place of learning. Perhaps it’s due to a belief that schools spend all of their time on academics, or that SEL should be the job of the parents; SEL is one area where some educators and leaders are saying enough is enough…Do I expect too much from schools? Do I expect a balance between SEL and academic learning that cannot possibly be accomplished?

There is much research by our friends at Marripedia, described by my National Pulse colleague Lisa Hudson, and mentioned in this space to show that fatherlessness is a much stronger predictor of crime, behavior, mental health, and educational problems than subjective, inaccurate mental screening and SEL programs will ever be. The tens of millions of dollars that Florida is spending on mental health would be far better spent on restoring and supporting two-parent families. Let us hope Florida voters understand and remember that this fall.


Dr. Karen Effrem is trained as a pediatrician and serves as president of Education Liberty Watch and the executive director of the Florida Stop Common Core Coalition.

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