The consent form must include the following information: TO: (parent or guardian)
FROM: (school or organization)

[Particulars regarding name of screening program, where and when it will take place]

FULL INFORMED CONSENT FOR MENTAL HEALTH OR PSYCHOLOGICAL SCREENING

Mental health or psychological screening methods for children and adolescents vary from state to state, but may involve a self-administered computer interview or survey to determine how a student feels emotionally (anxious or worried, sad or depressed) or to judge his or her behavior at the present time or in the past. These questions can cover thoughts or feelings your child has had or thoughts and feelings your child thinks you may have had or currently have about him or her.

An outcome could be you are asked to take your child for a follow-up interview or evaluation to determine if he or she has a mental disorder or syndrome. Based on an evaluation of your child’s answers, he or she may be diagnosed with a “”mental”” or “”psychiatric disorder””. These diagnoses have to be made by a psychologist, psychiatrist or medical doctor, but the subjectivity of this diagnostic process makes it a risk.

Questionnaires or tests are frequently based on symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the mental disorders section of the International Classification of Diseases (ICD). The psychologist, psychiatrist and medical doctor often
depend upon these diagnoses in order to bill private or government insurance.

The attitudes, beliefs, actions, inactions, or behaviors of a child or adolescent and whether or not these constitute a mental disorder are based on the opinion only of the person making the diagnosis. Unlike methods to determine physical diseases like cancer, diabetes or tuberculosis, a diagnosis of “”mental disorder”” or “”syndrome”” cannot be determined by any physical, medical test, such as a brain scan, a “”chemical imbalance”” test, X-ray or blood test.

Mental health screening could be presented to you as a means of preventing suicide. However, there is no scientific evidence to substantiate this at this time. The U.S. Preventive Services Task Force (USPSTF) studied this and recommended against screening for suicide in 2004, saying that it “”found no evidence that screening for suicide risk reduces suicide attempts or mortality””.

Commonly psychiatric drugs prescribed to treat mental disorders can have very serious effects on some children. In 2005, the European Committee for Medicinal Products for Human Use (CHMP), which includes members from 25
European Member States determined that antidepressants should not be prescribed to those under 18 years old because they can produce suicidal behavior, including suicide attempts and thinking about suicide and/or related behavior like self-harm, hostility or mood changes.

The U.S. Food and Drug Administration ordered that a “”black box””, its highest level of drug warning, be placed on antidepressant packaging advising that the drugs can induce suicide in children and teens. The FDA also has issued concerns that stimulant drugs prescribed to children may cause “”psychiatric events,”” describedas “”visual hallucinations, suicidal ideation, psychotic behavior, as well as aggression or violent behavior””.

Before consenting to any such screening or survey, the educational facility must provide a manual and other published information which fully describes:

(a) The nature and purpose of the screening/test or questionnaire.

(b) The development of the screening/test or questionnaire, its scientific validity as replicated in scientific studies, the rationale for the screening/test/questionnaire and reliability.

(c) Scientific journal citations demonstrating that the proposed screening/test or questionnaire has been proven to be reliable and valid by replicated scientific studies.

(d) A guarantee that no screening/test or questionnaire is based or related to any “”mental disorder”” as covered in the Diagnostic and Statistical Manual of Mental Disorders.

(e) The intended use of the results or outcomes of the child or adolescent completing such screening/test or questionnaire.

(f) The right to rescind consent at any time before, during or after the screening/test or questionnaire being proposed.

INFORMED CONSENT FOR MENTAL HEALTH SCREENING

I acknowledge that I have read and understood the above information to the best of my ability and have
read (NAME OF MANUAL), and based on my understanding, I am choosing one (1) of the following:

(a) I give my consent for my child to undergo an evaluation for emotional, behavior, mental, specific learning disabilities, or other health impairments (mental health screening), and require that I be provided, in writing, any findings determined.

(b) Consent means that I do/do not (strike which is inappropriate) give permission for the information obtained from such survey or testing to become part of my child’s school or other record or to be transmitted to any other agency outside of the [name of school].

(Signature of Parent) Date

(c) I do not give my consent for my child to undergo an evaluation for emotional, behavior, mental, specific learning disabilities, or other health impairments (mental health screening).

(Signature of Parent) Date

THIS FORM MUST BE RECEIVED BY THE PARENT AT LEAST 45 DAYS BEFORE THE PLANNED SCREENING. PLEASE ENSURE THIS FORM IS RETURNED BEFORE THE SCREENING DATE. YOU HAVE THE RIGHT TO REVOKE YOUR CONSENT AT ANY TIME

SOURCE: Added by P.L. 31-201:1 (May 9, 2012).