Jon Jureidini: Facts scarce on kids check

THE incorporation of an “evidence-based mental health and wellbeing check” into the Healthy Kids Check, which will now be targeted at 3-year-olds, has created considerable controversy.

Unfortunately, there is little hard information about the nature of the health check to guide informed discussion and allay the concerns of parents and health and welfare workers.

In September 2011 an expert group in child mental health was established to advise on:

• The design and use of the health check

• Mapping child mental health services nationally for inclusion in the national health call centre network

• A training resource for health professionals (GPs and practice nurses)

In a doorstop interview earlier this month, Minister for Mental Health and Ageing Mark Butler reported that the high-level expert group had already spent “some months” to get the design of that tool precisely right.

In the following days Professor Frank Oberklaid, chair of the expert group, was quoted as saying the check would involve checking the child’s progress against “a validated instrument of child development”, though he did not specify what tool. On the same day Professor Lyn Littlefield, executive director of the Australian Psychological Society and a member of the expert group, seemed to contradict that. She said on Sydney ABC local radio that the questionnaire would be a composite including questions taken from existing instruments.

We are yet to see either the content of the health check or the training resource.

There also seems to be significant uncertainty about the aim of the check.

It was announced as “an evidence-based mental health and wellbeing check” in the Budget announcement, which stated that “internationally renowned experts are telling us there is a growing body of evidence showing that you can identify kids with (or at risk of) conduct disorders [a diagnostic term in child psychiatry] or poor development very early — from 3 years old”.

Subsequently, in a departmental submission to the Standing Committee on Education and Employment Inquiry into mental health and workforce participation, the health and wellbeing check for 3-year-olds is cited amongst initiatives “strengthening the focus on the mental health needs of children, families and youth”, with a specific “aim to identify the signs of mental illness early” (my emphasis). Yet in his doorstop interview on 10 June Mr Butler said “it’s not screening for mental health issues”.

For any health screening exercise to be justified, certain conditions must be met, including:

• A screening tool must be available that validly identifies the target problem with a high level of specificity and sensitivity. Even a small reduction in specificity will result in huge numbers of false positives.

• Interventions of proven benefit must be widely and equitably available to those who screen positive.

• The overall benefits to the population must outweigh the harms, factoring in those individuals who receive the intervention who have been falsely diagnosed.

On the basis of publicly available information, the mental health check for 3-year-olds has not been shown to meet any of these criteria.

The current state of knowledge and understanding falls well short of that required to implement a pilot of this project, much less a population-wide intervention of this sort.

Professor Jon Jureidini is a child psychiatrist, department of psychological medicine, Women’s and Children’s Hospital, Adelaide.

Click here to read comment from Professor Stephen Leeder, who says we should wait for the final recommendations before passing judgement.

Posted 25 June 2012