Monday, August 31, 2009
Many teens who are depressed or suicidal are undiagnosed. We speak with the executive director from the TeenScreen National Center about a voluntary mental health check-up program for schools. We also speak with a local therapist about adolescent depression, how to tell if your teen is at risk and what to do about it.
Leslie McGuire, deputy executive director of the TeenScreen National Center for Mental Health Check-Ups at Columbia University.
David Peters, a licensed family therapist.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. Going back to school makes some kids happy, others sad, but there are much more serious ups and downs in many young people's lives. Pre-teens and teenagers can be subject to serious depression and, if there is no intervention, some may even start thinking of suicide. According to the Centers for Disease Control, suicide is the fourth leading cause of death for 11 to 18 year olds in California. A screening program is underway in some areas of the country, including a handful of schools in this state, to try to identify kids who are at risk for major depression and suicidal thoughts. The idea is to identify the teens and guide them to follow-up diagnosis and treatment. But, not everyone is thrilled with the idea. Critics say such a program may stigmatize kids who are merely going through typical teenage anxiety. Or, it may lead to the medication of depressed teens with prescription drugs that have potentially dangerous side effects. Joining me to discuss depression in teenagers and the current methods of screening for at-risk kids are my guests. Leslie McGuire is the deputy executive director of the TeenScreen National Center for Mental Health Checkups at Columbia University. And, Leslie, welcome to These Days.
LESLIE MCGUIRE (Deputy Director, TeenScreen National Center at Columbia University): Thank you very much. Thanks for having me.
CAVANAUGH: David Peters is a licensed family therapist with a private practice in San Diego. He treats adults and teens for a variety of mental disorders. David, welcome.
DAVID PETERS (Psychotherapist): Good to see you again, Maureen.
CAVANAUGH: And we invite our listeners to join the conversation. Tell us what you think about identifying kids who may be depressed or suicidal. Is this risky? Or is it a good tool for evaluating a student's overall health? Give us a call with your questions or your comments. The number is 1-888-895-5727, that's 1-888-895-KPBS. Leslie, why don't we start off by you telling us how this screening works.
MCGUIRE: Sure. So the way that screening works is it's a multi-stage process that, again, it's important to reiterate that this is a screening only, just like any other medical screening procedure. All that it's doing is identifying who might be at risk and needs further evaluation. In a school-based setting, the first step of the procedure is to obtain active written parent consent for screening. Another important part of this process is to obtain participant assent, so this is something that everyone is volunteering to take part in. The first step of the actual screening procedure involves the administration of a brief, self-completion, evidence-based screening questionnaire. And this is a questionnaire that looks at risk factors and symptoms of depression, anxiety, drug and alcohol abuse, as well as suicidal thoughts and behaviors. The vast majority of the kids who take the questionnaire screen negative and then just go on to a short debriefing interview. For the kids who score positive, though, they then go on and have a closer look with a mental health professional that's part of the screening team to determine whether or not the student, let's say, understood the questions, how severe the symptoms are, and, importantly, whether or not those symptoms that they endorsed are really causing any impairment in that student's life.
MCGUIRE: Are they having trouble at school or at home or with their friends? And if they are, then a referral is given so that the student can get a more complete evaluation.
CAVANAUGH: Leslie, let me ask you, what type of questions are asked on this questionnaire?
MCGUIRE: You know, there are a lot of different questionnaires out there. The ones that we use in the TeenScreen program ask questions like how much of a problem have you been having with feeling sad or unhappy? Have you thought about killing yourself in the last three months? Have you ever made a past suicide attempt? Things like that.
CAVANAUGH: And, once again, who evaluates the screening results?
MCGUIRE: A mental health professional so it's – it can be scored by a trained non-professional but if the student or the teen scores positive then they do go on and have an immediate assessment with a mental health professional.
CAVANAUGH: And David Peters, what kind of information could a mental health professional learn from a screening like this?
PETERS: Well, screening is a good way to quickly assess among a general population who might need to be looked at more closely. A mental health professional with, once they found the results, it was a positive result from such a screening, would look at them and say, well, okay, let's talk with the parents and let's make a referral to someone who can look more carefully because you need – for a definitive diagnosis, you have to have someone who's going to – actually going to talk with this teenager, maybe also talk with the parents, and observe behavior. And so it really just triggers a process in which a family then can utilize services available through their health insurance program or local community services or a therapist that they may know in the community.
CAVANAUGH: Leslie, how was the TeenScreen test developed?
MCGUIRE: Sure. It was developed, boy, almost 20 years ago at this point. And, as I say, we actually use a couple of – or, a few different screening questionnaires but the predominant one that we use in schools was developed based on risk factors for suicide that were determined by psychological autopsy studies of teens who had actually committed suicide.
MCGUIRE: So they learned from there, you know, what were the risk factors and the diagnoses of these kids.
CAVANAUGH: Tell us a little bit more about what a psychological autopsy might be.
MCGUIRE: Sure. This is a procedure where you go back and try and reconstruct the psychological state of teens who have died by suicide to determine what was going on with them at the time of their death. And these studies show that 90% of teens who do take their lives suffer from a psychiatric disorder at the time of their death, usually depression or another mood disorder.
CAVANAUGH: And how many TeenScreen programs are there here in California?
MCGUIRE: You know what, I don't know that number off the top of my head. I apologize.
CAVANAUGH: There are some here, I believe, in northern California, though.
MCGUIRE: That's right. I think there's about three, would be my guess.
CAVANAUGH: Okay. I'm speaking with Leslie McGuire. She's deputy executive director of the TeenScreen National Center for Mental Health Checkups. And I'm also speaking with David Peters. He's a licensed family therapist with a private practice here in San Diego. We're taking your calls at 1-888-895-5727. So, Leslie, you get the information from the screening and then it is evaluated by a mental health professional. Who does the diagnosis and what kind of treatment do you guide kids towards?
MCGUIRE: Sure. That's a really important point. Diagnosis and treatment are not at all part of the screening or part of the TeenScreen program. So once it's been determined that the teens have scored positive and the mental health professional has determined that a closer look is warranted, at that point mom and dad are called and someone from the screening team works with them to link them to a professional in the community of their choice. So it's at that point that professional, who's not connected to the screening team, would then do a thorough evaluation to determine diagnosis and determine any course of treatment but TeenScreen doesn't play any role in that process at all.
CAVANAUGH: Now that's an area where TeenScreen gets a lot of criticism because they say, well, you know, all – what are you going to do with families that, you know, don't have access to a mental healthcare professional? It can't afford it. There is no one that they want their kids to go to. What happens in a situation like that?
MCGUIRE: Sure. That's a great question. We do a lot of work with all of our local sites before they ever screen a single teenager to develop a referral network in their community because you certainly can't identify these conditions and then just say, oop, good luck to you parents. You really have to help them and know who takes which insurance, who's got a waiting list, who has a sliding scale fee, that sort of thing. And what we find is that we're actually very, very successful at linking kids to mental health services. In fact, in 2008, based on the data that were reported back to us from our local programs and sites, 89% of the teens who received a referral for more complete evaluation actually completed that referral and were connected to a local mental health professional.
CAVANAUGH: There are some people who want to join our conversation. I want to remind our audience we're taking your calls at 1-888-895-5727. Nancy is calling from Murietta. And good morning, Nancy. Welcome to These Days.
NANCY (Caller, Murietta): Good morning. Thank you for taking my call. I really think this is an important issue and I think it's a great idea what you're doing. My only concern is with privacy issues. If this is something that is going to be done in the schools, how would you address that? Is this something that if you did find the student, let's say, was suicidal or had some depression would this go into their, let's say, cumulative file? And do you refer them, let's say, to the parents and their own pediatrician or a mental health professional, would you help them with this?
MCGUIRE: That is a great question and that's another critical component that we work with all of our sites on before they ever screen, is to ensure that they have confidentiality protections in place. So the first and important thing is that in a school setting, teachers and administrative personnel are not involved in the screening so this is something that's done either by the school mental health professionals or by community-based mental health professionals who come into the school to do the screenings. And because of that, the screening results are kept outside of the academic record and are not shared with any of the academic personnel unless the parent wishes that to be the case. Now, obviously, if you've got a case of someone who's actively suicidal and it's an emergency, then there are different procedures that take place. But, you know, fortunately, that's, you know, more of a rarity. And in terms of the referral, it's up to the family. Some families feel comfortable starting with their pediatrician or their family practitioner and some want to go straight to a mental health professional. So the TeenScreen staff works closely with that family to find someone who can see the teen and also that meets the family's needs.
CAVANAUGH: Now, David Peters, you support the TeenScreen concept, and I want you – I'd like you to tell us why.
PETERS: Well, because many parents don't know when their child is depressed or at risk. And if you have a screening process installed in schools where kids are already going, lots of kids can be assessed very efficiently. It's – Efficiency is really a critical matter here because you have to be able to get the screening to the kid itself, and parents who don't have any suspicion of their child being depressed or anxious or at risk are not likely to take action on it. You know, assessing your kid for mental illness is not much different than assessing your kid in other ways. If you have your – if your kid's at school and he's sweating profusely, his color's not good, his eyes are not focused, and the school nurse says do you have a stomachache? Do you have a headache? Have you eaten anything strange this morning? The nurse is literally doing a screening for food poisoning or the flu or drug abuse, and no one has any challenge with that. We say, well, of course, that's what a school nurse is supposed to do. And maybe the kid has just been out running around playing football and says, no, I played too hard. The symptoms are indicated because of something else.
PETERS: But in some cases, the kid says, no, I don't know why I feel this bad but I feel really horrible, then the nurse can say, well, we need to get this child to a doctor, and calls the parents, the kid goes to a doctor. It's literally the same thing. In this case, there's a little bit more paperwork and bureaucracy to it. They need permission slips from the parents. I would advocate being able to go – have the school do it without permission slips but TeenScreen is a conservative program doing this in a way that is cooperative with families and doing this very slowly. But to assess is a way to intervene early and we're talking about saving lives, and not only the life of a child who may be with a mental illness but this could also save lives of children who don't have mental illness. We've had, in the last ten years, two different high school shooting incidents in San Diego County. Well, what if six months before those happened, TeenScreen had been there and students were screened for depression and several of those students who perpetrated those crimes were found to be suicidal, to have hopelessness, have serious depression and they were referred to their family members to go get help and the family members called the doctor and there was intervention. Other children would be alive today.
PETERS: So we're talking about saving lives in a multiple number of directions. And even if we're not talking about saving lives, we're saving academic careers, we're saving kids from future prison time, we're saving human brains because the longer a child stays with the brain in a depressed state, there's literal damage to the brain done as the years go by. Cognitive functioning becomes diminished.
CAVANAUGH: I want to ask you quickly, David, do we have any statistics on how many undiagnosed depressed or suicidal teens there may be?
PETERS: I'm not a very good demographer. I think what will – the best we can go by is looking at what we do know in terms of it being the fourth leading cause of death…
CAVANAUGH: Right, right.
PETERS: …among teenagers, etcetera. But to know how many kids are not diagnosed, you know, it's like trying to know what you don't know.
CAVANAUGH: Exactly, yeah.
PETERS: It's speculative. There's ways of determining that but I'm not a good demographer in that area.
CAVANAUGH: Well, we have to take – Oh, go ahead, Leslie. I'm sorry.
MCGUIRE: I was just going to say, there was actually a recent study done by SAMHSA, which is a federal mental health agency and they were documenting the rates of adolescent depression and as part of that study, they actually showed that only two-fifths of those with depression get any kind of treatment. So…
MCGUIRE: …I think you can assume, you know, it's the three-fifths who not only are undiagnosed but also untreated.
CAVANAUGH: We have to take a short break. When we return, we'll continue to talk about teen depression and the TeenScreen concept, and we will continue taking your calls here on KPBS. You're listening to These Days on KPBS.
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CAVANAUGH: I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. We're talking about the TeenScreen mental health program that is being used in schools across the country. There's only a few schools involved in California and none in San Diego, I want to make that point. The screening helps identify teenagers who are at risk for depression and suicide. And my guests are Leslie McGuire. She is with the TeenScreen National Center for Mental Health Checkups. And David Peters, who is a licensed family therapist here in San Diego. We're taking your calls at 1-888-895-5727. Lots of people want to join the conversation, so let's take a few calls right off the bat. Mike is calling in Point Loma. And good morning, Mike. Welcome to These Days.
MIKE (Caller, Point Loma): Thank you. I am a – I'd better qualify my questions here. I'm a retired clinical research psychologist there, haven't had a license for, oh, over ten years there, but I do volunteer, still do kind of, quote, pro bono work with a number of social survey – I really have a concern about this. I really, really do. You know, because, A, we know that teens, you know, going through, you know, you know, junior high and high school go through a lot of, you know, underlying hormonal changes and there can be moments where they're in deep despair and the next moment in, you know, great ecstasy with something happening to them and whatever, like that. And then the concern then is that, you know, okay, how do you screen it? Do you screen everybody or do you, quote, select out, you know, people, you know, that refer by the parents, the teachers, the staff, whatever, to that? And soon it will be known, oh, 'X' is going in to be screened there so he or she must be going loony or is going to kill him or herself sort of thing. Also, I'm really not aware, not that I stay on top of everything there, not aware of any validity of this test, you know, in predicting whatever, you know, that has it really reduced the incidence of, you know, mal behaviors or suicides, whatever where it has been used over the year – you know, as they're saying it's been around for 20 years.
CAVANAUGH: Sure. Mike, I…
MIKE: I'm not aware of it, you know, and I'm just really concerned is that the underlying costs – Why don't we spend the money for, you know, having, getting, or maintaining school nurses at schools because right now they've been cut back with budget cuts and, god love them, you know, that to me the school nurse, with the teacher, is the first line of defense of dealing with these sorts of issues and we're…
CAVANAUGH: Mike, I'm going to have to stop you right there. We've got your question. Thank you so much for calling in. And I want to have both Leslie and David respond to some of your concerns there. And, Leslie, how would you respond to Mike?
MCGUIRE: Sure. The first issue was really important and that is that the TeenScreen process involves a two-stage screening questionnaire so while the screening questionnaire – or, two-stage screening process. The screening questionnaire can certainly pick up a kid who has a more transient type issue. The fact that every single kid who scores positive goes on and has an immediate interview with a mental health professional, those kids get weeded out. It's really only the kids who have significant levels of symptoms over a prolonged period of time and that the symptoms are causing significant impairment in their lives at home, at school or with their friends, those are the kids who are getting referred on. It's not the kids who, let's say, just broke up with their boyfriend and are having a bad day. That second-stage interview really cuts that out. The other issue of stigma is an important one and we take a lot of care to make sure that the kids who are screened are not stigmatized. So the screening is not done, let's say, in a classroom where some kids are doing it and some kids aren't. Kids are brought out confidentially at the start of a class period. It's really not known what they're leaving for, they're not returning in the middle of the period. It is a quiet and confidential process. The last bit about the research, there actually is a great deal of research out there about the TeenScreen program and screening in general and I won't go into the specifics on that just for lack of time but I will say that TeenScreen has been evaluated by the Substance Abuse and Mental Health Services Administration and is included in their federal registry as an evidence-based program.
CAVANAUGH: And, David, I want to give you a chance to respond as well.
PETERS: Yes, I think the phrase 'evidence-based program' is really important, meaning that it's not just someone's opinion that something works, it's that we have good scientific evidence through research that something works. And keep in mind, when this discussion – things get truncated down to simple statements such as this screening process diagnoses kids and sends them off to get medication. No, it doesn't. The screening process screens out who may be at risk and who should be evaluated. It's not the evaluation, it's a screening process to get people to evaluation. That's a very critical factor. And do we have paper and pencil tests or computer generated tests that are accurate and proven with predictive validity? Yes, we do. And we have for some time. TeenScreen uses some that have been tested with good research, and there's others available. It's not a new product out here. For 20, 30 years, we've had a variety of different screening pros – questionnaires and things available to assess for bipolar disorder, to assess for learning disabilities and everything. These are tools that have been well established. And I agree with the caller that the school nurse should be a good front line defense but a school nurse can evaluate one person at a time and they're already overwhelmed with kids who are sick. What this allows is to evaluate much larger numbers of students without burdening the school nurse, who's already overworked. And so we are talking about connecting people with mental health professionals when necessary but they're not forced into anything. The evaluation takes place and some kids, they'll say, you know what, you tested positive on this screen but, you know, we think that just talking with your parents more is going to be the answer. It's just a normal bad month for you, right now.
CAVANAUGH: Umm-hmm. Let's take another call. Valerie is calling from North County. Good morning, Valerie, and welcome to These Days.
VALERIE (Caller, North County): Good morning.
CAVANAUGH: Yes, how can we…
VALERIE: Good morning.
CAVANAUGH: Good morning. How can we help you?
VALERIE: I just am calling especially in referral to the stigma and I really see this as, you know, talking about mental health and just the whole child rather than academic performance or extracurricular performance, you know, that bringing into the light the whole needs of the student as a positive thing and bringing this into the open. And I speak from personal experience. One of my children has really struggled with depression and we often ask, you know, why didn't somebody alert us. Our family was dealing with chronic illnesses and we took care of the physical needs but, you know, we're – if a school official or someone had talked to us and said, you know what, we're seeing these things happening with your child and we would've had some help in dealing with the mental health challenges, you know, I think it would've saved a lot of heartache and trouble down the road. But those are just some – some personal thoughts.
CAVANAUGH: Well, thank you for them, Valerie. Thanks for calling.
MCGUIRE: Can I just comment on that?
CAVANAUGH: Yes, I think both of you want to comment on that. Let me ask David for his comments first and then I'll go to you, Leslie, okay?
PETERS: Well, I'm appreciating Valerie's comment about the stigma. You know, I've worked with lots of teenagers over the years and what people don't realize is that among the circles of teens frequently they know who's depressed, they know who's talking about killing themselves, and they're not talking about it. They're not reporting it. We can try and convince them over and over again, tell us if someone in your group of friends is, you know, seriously depressed or needs help, but kids don't think rationally. Kids' brains aren't fully developed. Even teenagers, they don't think rationally. They will have, without even agreeing to it, just a certain code of silence about, well, you just don't expose your friend who's talking this way. And they know, sometimes, who's in trouble and the parents don't know. And so you – the stigma becomes an irrelevant question. Students often know. Well, this guy's really sad or, you know, he – he's one of those who's always talking negatively, and then again there are some who are completely hidden and who explode outward in something God awful, and both can be helped with the screening process.
CAVANAUGH: And Leslie.
MCGUIRE: Sure. I think your comments were so important and insightful. And that two things that I've seen doing this work are that, number one, the kids themselves are so grateful that an adult is asking them these questions. And whether or not they're symptomatic, they're grateful, or whether or not they're completely fine, they think it's a fantastic idea because they know a friend or they know someone else who's struggling with these issues but they don't quite know what to do with that information. The other really critical thing that's always stood out to me, having done this work, is that you find kid after kid after kid who is in a really terrible place, severely depressed, thinking about suicide but yet they're getting up, they're going to school and no one knows. They're not diagnosed, they're not treated, they're not getting help. And when you ask, every single one of these kids, you know, how's this possible, I've gotten the same answer from everyone: Nobody ever asked me. They want to talk about this but they don't know how to raise it but no one's asking them these questions. But with screening, every kid can be asked these questions systematically, giving the kids an opportunity to really get the help that they need.
CAVANAUGH: You know, Leslie, one of the major controversies surrounding the TeenScreen concept is the idea of medicating teenagers. You know, there was a flurry of reports and congressional hearings in the last years about the risks of giving powerful brain chemistry altering drugs to teenagers. And I'm wondering, could TeenScreens lead to just forcing prescription pills on troubled kids?
MCGUIRE: Absolutely not. So as I said before, screening does not lead to diagnosis, screening does not lead to treatment and especially it doesn't lead to any specific kind of treatment like medication. That's a decision that is always made with the family. So if the family doesn't want medication, the family's not going to get that. I think also in, especially in teens, the first line of defense usually is therapy. And what we've seen from some surveys we've done with parents whose kids have been identified by TeenScreen and sent on for referral, it's a very small minority who even get evaluated for medication, less than 10%. So the most of the kids who do get referred on are going on for therapy or brief intervention.
CAVANAUGH: So that whole idea that, well, a lot of people don't have health insurance, David, a lot of people don't have health insurance, they won't be able to get treatment for their children in any kind of therapeutic situation, so all they'll do is start giving their kids pills, that, David, you don't see that as a scenario resulting from a TeenScreen program?
PETERS: It all depends on what the parent decides to do. If there's no health insurance, they're probably not going to get any pills at all even if they need them. But we have, as we know from listening to the national news, we have a healthcare crisis where there's a lot of people who don't have access to good health insurance. By the way, we do have publicly funded support available if people get in touch with social service agencies. Dialing 211 on their telephone can connect them to a source that will give them access to low cost mental health support services. And there are some cases where medication may be necessary and that scares a lot of people if you talk about forcing kids on pills but medications have saved thousands and thousands of adolescents' lives across this country. There's no doubt about it. The research is well grounded. You get the congress involved debating things over – because they hear things from one piece of research or two pieces of research that there's a risk, yes, there's a risk with every medication we take. And what we do want to say is this, if your child goes to the pediatrician and the pediatrician prescribes a medication and says, okay, bring him back in a month, you don't have proper intervention.
PETERS: If your child is depressed, your child should be going to a family therapist or a psychologist who knows how to work with children or teens and that therapist, more than likely, just with counseling and talking with the family, can help resolve a few problems and prevent any need for medication. There's – We have powerful therapies that are verbal therapies and family interventions that can change everything. If a medication's necessary, then a referral to a psychiatrist who's trained to work with teenagers is the next step and you watch the process carefully. Both have to go at the same time.
CAVANAUGH: I want to take one last call. Peter is calling from El Cajon. Good morning, Peter, and welcome to These Days.
PETER (Caller, El Cajon): Oh, how are you doing this morning?
CAVANAUGH: Great, thank you.
PETER: I have a quick question for you. My daughter is 17. She's struggled off and on with depression, and she has attempted suicide a couple of times by not taking her insulin. She's a type I diabetic. She's going to be turning 18 by the end of this year and I didn't know if there's any vehicle or any organization that we can use that we can still intervene in her situation after she becomes an adult.
CAVANAUGH: I see what you're saying. Thank you for that. And, David, I'm going to ask you.
PETERS: Yes, it's a challenging question because I'm not a lawyer. But I do believe that it is legal if you experience that your daughter, even though she's over 18, is at imminent risk because of illness in any way, that you can take her to a hospital and have her evaluated. Once you get her in a hospital emergency room, the law takes over from there and – and they do screen at hospital emergency rooms for suicidal thoughts and things if you tell them that you believe this person is at risk. And they can make sure the person's getting the appropriate medication, in your child's case insulin. It's a difficult question. If I had an adolescent who several times is not taking medication and was turning 18, I'd want her hooked up with a therapist to see on a regular basis, every two weeks at least or even once a month, to have an ongoing relationship with her to help her maintain her physical and her mental health. That's the best way to prevent problems in the future.
CAVANAUGH: Leslie, I wanted to ask you, how is the TeenScreen program spreading? Are we going to be seeing this coming to Southern California anytime soon?
MCGUIRE: I can't say about Southern California anytime soon, I'm not sure.
MCGUIRE: But the program has really grown a lot over the years so we – we've launched nationally in 2003 and now have more than 650 sites in 43 states. So it pretty much is an on-demand sort of thing. We have schools and community groups and medical providers and facilities who come to us and request our assistance and our materials, which we do provide for free.
CAVANAUGH: And – oh, for free. That was going to be my question. Do you know how much this program actually does cost though for schools to implement it?
MCGUIRE: You know, it depends entirely on how they staff it, how many kids they want to screen, so there's no straightforward answer to that. But, again, any materials and the consultation we provide are free. And lots of the sites that are out there run on a budget of zero, so they get volunteers, they get interns, they get people to wear another hat on top of the ones they already do. So it really just depends on the community and what their resources are.
CAVANAUGH: And David.
PETERS: Yes, I'd like to say we do need this sort of program in San Diego County. And anybody who is listening can call their school district and say I heard about the TeenScreen program and I think we should implement it here. If parents tell their schools and the school districts that we want this program here, that's the way this gets generated.
CAVANAUGH: Well, I want to thank you both so much for sharing your information with us today. Now, Leslie McGuire, deputy executive director of the TeenScreen National Center for Mental Health Checkups at Columbia University. Leslie, thank you.
MCGUIRE: Thank you.
CAVANAUGH: And David Peters, a licensed family therapist with a private practice here in San Diego. David, once again, thanks so much for coming in.
PETERS: Always good to be here, Maureen.
CAVANAUGH: And I want to tell everyone who we couldn't get on the air today that you can post your comments about this segment at KPBS.org/TheseDays.