Reducing Risk: Our Response to the CT Tragedy

• December 17, 2012
• Jennifer Salerno

After the Connecticut shooting, President Obama in his address to the nation stated we need to “take meaningful action to prevent more tragedies like this.” Discussion is on gun control and although stronger gun policies may help, this not a solution to the problem – we need to identify at risk youth in their middle and high school years and provide appropriate counseling and referral services to prevent them from future acts of violence.  In the US there are many recommendations for risk screening in teens. The Centers for Disease Control and Prevention recommend screening teens in six categories of risk that are known to contribute most to morbidity and mortality, including unintentional injury and violence. The American Medical Association created recommendations that include annual risk behavior screening. The American Academy of Pediatrics Task Force on Mental Health recommends routine, periodic screening using validated instruments to identify adolescents with mental health symptoms. Despite these recommendations, provision of adolescent screening for risk behaviors remains far below recommended levels and failure to screen has led to serious sequelae. It has been noted that 80% of children do not receive much needed mental health services. The Institute of Medicine states that mental health screening offers the potential to intervene early and prevent fully developed disorders. Studies have shown that identification of mental health symptoms, improved access to services, and provision of interventions before the onset of fully developed disorders offers the greatest cost effective approach.

Sweeping change needs to be instituted that calls for adolescent screening in primary care offices, middle and high schools, and universities with mandates for appropriate reimbursement. We are ignoring teens in our country because of lack of understanding of the impact of risky behaviors; limited risk identification at a time when interventions would be most effective; and lack of incentives, training, and resources for professionals working with teens. Time efficient, validated surveys exist for professional use. Preliminary data from a study of teens in Michigan shows significant decreases in risky behaviors following identification, risk reduction counseling, and appropriate referrals. In order to prevent reoccurrences of Connecticut, Columbine, and Virginia Tech requirements for risk identification and intervention need to be instituted.