Stephen Leeder: Don't judge too soon

SCREENING is always controversial. It has the capacity to convert a person into a patient even though they may feel perfectly well.

It can label a person with a disorder — hypertension or whatever.

Accumulated wisdom distilled from a vast literature has applied a brake on the earlier enthusiasm for screening, although once in a while a fresh outbreak of screening enthusiasm pops up.

Before embarking on screening, the research data caution us to ask questions and provide answers on issues such as, if we find something during a screening test, what does it mean? Who will follow up abnormalities detected at screening?

At a health system and policy level we ask, how does the cost and effectiveness of a screening program compare with those of treatment programs competing for scarce health dollars?

“First do no harm” should be the first priority applied to all screening.

In 2002, the NHMRC published a report on screening children. Under the leadership of paediatrician Professor Frank Oberklaid from Melbourne, the 250-page report considered all the commonly recommended screening tests for children — hearing, hips, hypothyroidism and many more — and explored the available data. Suffice to say that evidence for the value of many screening tests was scant.

By a complex policy pathway, the $25 million Healthy Kids Check, introduced nationally in 2008, is under revision to align it more closely with evidence of effect.

Under the revision, the age at which children are assessed will change from 4 to 3 years and, according to a report in The Australian, it will “check the child’s immunisation status, allergies, height and weight and ask parents if they had any concerns about their child’s behaviour”.

Professor Oberklaid and colleagues continue to advise on the content and form of this program. In the report in The Australian it said the assessment “involves checking the child’s progress against a validated instrument of child development”.

“Each of the criteria to be used was based on peer-reviewed evidence that has been ‘solidly tested’ and used in the US, Britain, and sometimes in Australia”, the newspaper reports Professor Oberklaid as saying.

Great concern was raised by American psychiatrist Professor Allen Frances, while visiting Australia, about “an explosion of false diagnoses that would see youngsters overmedicated and labelled with a mental illness for life”, but that seems not to be a major worry with this proposal.

The knowledge and expertise of the group of experts in child mental health advising on this program provides assurance that any check of a child’s mental health and wellbeing as part of the Healthy Kids Check will be based on good evidence. Let’s wait to see their final recommendations before we judge this new initiative.

Professor Stephen Leeder is the director of the Menzies Centre for Health Policy and professor of public health and community medicine at the University of Sydney.

Click here to read comment from Professor Jon Jureidini, who says there is little hard evidence to support mental health checks for children.

Posted 25 June 2012

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