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.
*This article was previously published in MJA Insight 25/06/12
