Washington Schools’ Mental Health Survey Puts Student Gender and Sexuality Data at Risk

In an effort to curb substance abuse and flag student mental health issues, in 2018, Washington state’s King County started giving students an unusual electronic survey.

The Check Yourself screener, which is conducted in classrooms on school-issued iPads or laptops, first displays a short disclaimer indicating that the collected information is confidential but not anonymous to the school. Students who click “I accept” are then asked a series of questions about their gender identity and who they are most likely to have a crush on, as well as their age and race. The assessment also asks about drug and alcohol use, how much sleep students get, and levels of anxiety.

When students submit the survey, their name is stripped from their responses and replaced with a unique proxy identification code in an attempt to abide by federal privacy regulations. Then the data leaves the school system.

“There are no guardrails.”

King County student data is sent to the servers of Tickit Health, a Canadian health tech startup, which built the digital screening tool. There, it can be accessed and downloaded by King County employees. Student data is analyzed by the county to gauge the students’ mental health and used to direct help to those who might be at risk for self-harm. According to a research plan obtained by OneZero via a public records request, the data is also used for a research study by doctors at Seattle Children’s Hospital, which created the screener, to test if the screening process actually works.

Observers say the mental health data collected by these schools raises serious concerns. At a minimum, these systems create a government-owned dossier of students’ most personal information—data that is much more sensitive than exam grades and vaccination records.

Gathering and digitizing detailed data on a student’s sexuality and demographic information in the classroom also makes that data vulnerable to hacks or leaks. Researchers and experts who have worked closely with the type of program undergirding the Check Yourself assessment have also voiced concerns about how it has been adapted for King County.

While King County is one of the first to pursue this level of data collection in schools, the growing demand for mental health and digital tools in education means it’s unlikely to be the last. In recent years, vendors, including startup WellScreen, have begun to market digital screening tools to schools, and universities like UC San Francisco and Baylor School of Health have developed apps for clinical use.

Schools have already adapted digital systems for many classroom tasks. Online portals for parent-teacher communication have become the norm in school districts across the country, and ed tech is a field now worthy of venture capital investment. Even essay grading and checking for plagiarism are being automated.

Now, data collection is coming for social services, such as counseling. The United States is grappling with an ongoing mental health crisis in teens and young adults. The rate of teen suicide increased 56% from 2007 to 2017, with 6.8 out of every 100,000 teens dying by suicide in that time period. In Washington, detecting mental health issues in young people is especially crucial. The state department of health reports that 87 school-age children died by suicide in 2017 alone, the latest data available.

King County is one of the first counties in the nation to adopt digital tools to conduct mental health screening in its schools. It was originally estimated that 35,000 children would take the county’s in-school screener, though not every school signed on to be a part of the initiative. These screenings are not anonymized within the school district, and address sensitive issues beyond drug and alcohol consumption to include questions about gender, sexuality, and whether parents drink at home. Eleven of King County’s 19 schools now use the Check Yourself program, meaning thousands of students will take the screener this school year.

“One of the questions was even about sexuality and sexual identity and issues at home, and I thought, that’s not what this [screener] is about.”

King County’s in-school screening might be a harbinger for how digital and mental health is managed in schools across the county. In California, schools use the Healthy Kids Survey, which differs from Check Yourself in its anonymity and paper submission. California also asks detailed sexuality and gender questions but publicly discloses that no psychological or social harm has been reported in 14 years of conducting the survey.

The Check Yourself software is a new variant on a model called Screening, Brief Intervention, and Referral to Treatment (SBIRT), designed to screen young people for mental illness by their health care provider to catch early signs of depression, anxiety, or self-harm. The screener was developed by doctors from Seattle Children’s Hospital and the University of Washington, and the software was developed by Tickit Health. Each school district in the county has a data-sharing agreement allowing King County and Tickit Health to receive the student data.

Data breaches have become alarmingly commonplace, with more than 120 data leaks reported at U.S. schools in 2018 alone. That could pose a risk for the Check Yourself program. Check Yourself survey data remains on school servers for an indeterminate amount of time. Tickit Health retains the data throughout the summer of the previous school year. That’s a liability for students if these servers are ever breached.

And Washington state has had plenty of data leaking incidents: Tukwila School District, which uses the Check Yourself screener, fell victim to a phishing scam in December 2019 and leaked an undisclosed amount of data. King County says that no Check Yourself data was lost. Northshore School District, which also uses the Check Yourself screener, had its network attacked in September 2019, though there’s no evidence of data being stolen. In 2016, 9,000 Northshore students had their email accounts breached. The University of Washington Medicine department, which helped create the BSK screener, leaked data on 974,000 patients when its system was breached in early 2019.

Disclosures about Check Yourself data collection can also be inconsistent. While parents were notified about the Check Yourself screening, school districts within the county differed in how they notified parents about the program. Northshore School District followed an opt-in policy while Kent and Tahoma school districts adopted an opt-out system. None of the information or disclaimers online accurately communicate the detail of questions inquiring about a student’s gender or sexuality.

Asking sensitive questions in a school setting comes with risks, experts warn. King County’s Check Yourself screener asks detailed demographic information, unlike nearly all similar screeners. And although King County documentation stresses that no identifying information is attached to students’ answers, survey responses could still be used to identify students. For instance, the screener includes text boxes where students can type in their own response. Since these are not standardized, even after a name is removed, responses could be used to identify students.

Screening researchers and experts who have implemented the SBIRT system elsewhere also say that assessment isn’t meant to be extended beyond screening for drug and alcohol use and that the inclusion of screening for gender, sexuality, or mental health concerns could endanger students.

Mary Ann Gapinski, the former director of School Health Services for the Massachusetts Department of Public Health, led that state’s universal adoption of the SBIRT system in schools. Massachusetts now operates the country’s largest implementation of school-based SBIRT. Gapinski says that she questions the way King County is adopting the screening tool.

“When I heard the way they were implementing it [in King County], so many red flags went up for me because I know this isn’t safe for the kids,” she said. “One of the questions was even about sexuality and sexual identity and issues at home, and I thought, that’s not what this [screener] is about.”

Charol Shakeshaft, a professor at Virginia Commonwealth University who studies sexual abuse at schools, told OneZero of the King County data collection, “there hasn’t been any real conceptual and safety overview thinking about all the ramifications for how you would use this data. There are no guardrails.”

It appears as if even Tickit Health, the company that built the Check Yourself screener software, does not market the program for use in school settings. The company pitches its software for use in a clinician’s office rather than a school, a post on its website notes.

“Electronic risk screening may be an effective and sustainable solution to increase screening rates, but little is known about the effectiveness of electronic screening tools in capturing data or decreasing risk,” the site says.

Meanwhile, federal health officials argue that in-school screenings and data collection efforts like SBIRT are the future. The Substance Abuse and Mental Health Services Administration released a 75-page report in January 2019 that argued universal mental health screening should be the norm in schools and detailed steps on how to set up screening.

“Emotional or behavioral health issues are generally detected after they have already emerged. It is time for that to change,” the report’s opening page reads.

King County provided OneZero with seven preliminary testimonies from schools that had started to implement the Check Yourself tool. Each of them testified to the program’s success: School districts reported the program potentially stopped two suicides and led to the referral of one student for help through child protective services.

Margaret Soukup, the program manager now in charge of SBIRT in King County, is the main driver for bringing the Check Yourself screener to King County. A 10-year veteran of the juvenile justice field, Soukup first saw the SBIRT intervention model in use by a group called Reclaiming Futures, funded by the Conrad. N. Hilton Foundation. She thought that the program could be even more helpful if students were screened before they had to meet with truancy officers or got wrapped into the juvenile justice system.

Soukup says that the first round of data from real students is just now coming back to the county, and the initial results suggest the program is working to find teens who might be prone to self-harm. She also says that the county is still adapting to what they find as they continue to implement the program.

“We’re definitely learning as we go along,” she says. “It’s a way to start a conversation and identify young people who need connections, what we’re hearing anecdotally is that I feel like I’m seen, and now they know who to talk to when their friends aren’t feeling great.”