"The two words ‘information’ and ‘communication’ are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through." -- Sydney J. Harris

Most Minnesota kids not getting mental health screenings

Fewer than half of adolescents taken to Minnesota clinics for well-child exams last year were screened for mental health or depression, according to a report released on Thursday.

But among the 43,400 youngsters who were screened, 4,300 — or 9.7 percent — had indications of a condition such as depression, anxiety or attention disorders, according to the report by the state Department of Health and MN Community Measurement, a nonprofit dedicated to publicly reporting health care information.

The screenings matter, said Sue Abderholden, executive director of the nonprofit National Alliance on Mental Illness Minnesota.

“One thing we forget is that mental illnesses are a young person’s illness,” Abderholden said. “Most people begin experiencing the symptoms before the age of 26 and half before the age of 14. With any illness, we know that identifying it early and treating it, that’s when you have the best outcome.”

linics in the Northland were all over the map when it came to frequency of screening adolescents for mental illness, according to the report. The Fairview Mesaba Clinic in Nashwauk led the way regionally with 93.8 percent screened; followed by St. Luke’s-affiliated P.S. Rudie Medical Clinic at 89.4 percent. At the other end, Gateway Family Health Clinic in Moose Lake screened 0.6 percent.

The Sawtooth Mountain Clinic; the St. Luke’s-affiliated Laurentian and Miller Creek clinics; and Essentia Health’s Proctor, Lakewalk, Lakeside, Deer River, Ely, Hermantown, Virginia, Hibbing, Duluth and West Duluth clinics all fell below 10 percent.

The statewide average was 40 percent.

Screening at all ages for mental illness is considered a priority at Fairview Mesaba clinics, said Paula Pennington, who manages Fairview Range Medical Center’s behavioral health unit. In addition to the Nashwauk clinic, Fairview Mesaba clinics in Hibbing and Mountain Iron also had above-average screenings — 67.8 percent and 57.3 percent.

Dr. Timothy Zager, a pediatrician who is division chairman for primary care at Essentia Health-Duluth Clinic, said that until March of this year Essentia clinics used a different, broader screening tool for adolescents developed by Dr. Sharnell Valentine, also an Essentia Health-Duluth Clinic pediatrician.

That tool, the adolescent health questionnaire, is given to all adolescents as part of exams, he said. But it wasn’t counted in the MN Community Measurement report.
A follow-up screening tool, used by Essentia when adolescents have shown signs of depression, is one of those approved by the agency, Zager said. In March, Essentia started using one of the approved screening tools for all adolescents as part of exams.

St. Luke’s clinics don’t screen all adolescents, said Sandra Barkley, St. Luke’s vice president of clinics. “There are certain timelines in which we would screen, (but) not everybody for every visit,” she said.

The screening tool is a series of questions, answers to which have been clinically shown to reveal the possibility of mental illness, Abderholden said. She compares it to a thermometer — it doesn’t diagnose an illness, but it can indicate a closer look is needed.

“A screening doesn’t tell you that your child has depression; it tells you there are warning signs there,” she said.

Nor is it a time-consuming addition to a well-child exam, Abderholden added. “I don’t think this is a huge burden, and I think it’s important that the screening be done early.”

Depression is common enough to make screening worthwhile, Zager said.

“I think what MN Community Measures is trying to do is say there are a lot of things boiling under the surface for adolescents, and you’ve got to have a way to probe the surface that has some degree of reliability,” he said. “Because if you don’t look, you’re not going to find it.”

Obesity counseling

The Northland, and the state as a whole, fared much better in another measure: providing lifestyle counseling to obese children.

Statewide, 85 percent of clinics counseled overweight and obese children about nutrition and physical activity, according to the report. But 25 of 32 clinics in the Northland counseled better than 90 percent of those children, and six — Scenic Rivers Health Services in Bigfork/Big Falls, Fairview Mesaba Clinic in Nashwauk and the Essentia Health clinics in International Falls, Aurora, Hibbing and Proctor — each counseled 100 percent.

Only the Sawtooth Mountain Clinic in Grand Marais and Essentia Health’s West Duluth Clinic scored below the state average (68.8 and 67.3 percent, respectively).

According to the report, 28.6 percent of children ages 3-17 in Minnesota who had a well-child exam last year were overweight or obese. The most recent national rate was 31.8 percent and included 3- to 19-year-olds.

This was the first time these two measures have been reported in Minnesota, according to a news release from MN Community Measurement.