In several of the included studies in the sexual activity domain, researchers looked at attitudes of adolescent patients, parents, and clinicians toward adolescents being screened in acute care settings. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. RCT, randomized controlled trial; , not present; +, present. Nonpsychiatric ED patients who were screened had a 5.7% prevalence of SI (clinically significant), and screening positively did not significantly increase the mean length of stay in the ED. Forty-six studies were included; most (38 of 46) took place in the ED, and a single risk behavior domain was examined (sexual health [19 of 46], mood and suicidal ideation [12 of 46], substance use [7 of 46], and violence [2 of 46]). The Newton Screen may be a good brief screening tool for assessing alcohol and cannabis use. In this scoping review, we aim to comprehensively describe the extent and nature of the current body of research on risk behavior screening and risk behavior interventions for adolescents in urgent care, ED, and hospital settings. Almost all adolescents agreed that nurses should screen for suicide risk in the ED. These brief validated tools within single risk behavior domains could potentially be combined into a single comprehensive screen (with consideration that these screening tools may have been validated for specific populations and plans to assess feasibility and time burdens). The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! A significant proportion of adolescents were interested in starting contraception in the ED. EC knowledge was poor among clinicians surveyed. We conducted a scoping review given expected heterogeneity of the body of literature on this topic. 2003; 122(6):1387-1394; and American Academy of Pediatrics Section of Pediatric Dentistry. Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. RT @nancydoylebrown: David Leonhardt continues: "The effects were worst on low-income, Black and Latino children. Self-disclosure screening tools have been shown to increase privacy and disclosure of sensitive information by adolescent patients when compared with face-to-face screening by a clinician.68 The use of technology and creation of electronic self-disclosure screens may further provide means to maintain comfort and patient privacy while streamlining workflow and maximizing efficiency for clinicians, particularly when a reminder to screen is integrated.21,22 Special consideration should be given to the interplay between documentation of sensitive information in the EHR and the privacy and confidentiality crucial in screening for adolescent risk behaviors.69 One strategy to mitigate possible breaches of confidentiality with EHR documentation is to mark risk behavior screening notes as sensitive or confidential, thus preventing parents or guardians from access to the note (an option that is available on most EHR software). Adolescents have suboptimal rates of preventive visits, so emergency department (ED) and hospital visits represent an important avenue for achieving recommended comprehensive risk behavior screening annually. Prevalence of IPV was 36.6% in screened patients. A majority of patients in the ED did not prefer EPT, and clinicians should address concerns if they do plan to prescribe EPT. Assessment of Respiratory Function in Infants and Young Children - JAMA 1, 6 Studies indicate that a majority (62%-70%) of adolescents do not have annual preventive care visits, and of those who do, only 40% report spending time alone with a The authors noted that although 94% of patients in the study were documented as sexually active, only 48% of charts documented condom use, only 38% of charts documented STI history, and only 19% of charts documented the number of partners. Assessment and Action | AAFP - American Academy of Family Physicians Audit of sexual activity and risk-level status documentation. There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. Questionnaire used to assess beliefs regarding screening and intervention for suicide risk and other mental health problems in the ED. Interview, primary question of interest: Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. Adolescent Risk Behavior Screening and Interventions in Hospital It is important to conduct adolescent substance use screening in the ED. Preventive oral health intervention for pediatricians. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. The ACE (Acute Concussion Evaluation) forms are patient assessment tools. Six of 46 studies that were included in our review were focused on comprehensive risk behavior screening and/or interventions (across all risk behavior domains), as summarized in Table 2. Further study of technology-based behavioral interventions is warranted. 10.1542/peds.2020-020610. screening1,2 responsible adult is a modified HEADSSscreening, which has toask the rightbeentaught in adolescent medicine and pediatric training questions. hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd In a 2011 systematic review of substance use screening tools in the ED, the authors concluded that for alcohol screening of adolescent patients, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 2-item scale was best, with a sensitivity of 88% and a specificity of 90% (likelihood ratio of 8.8).55 For marijuana screening, they recommended using the Diagnostic Interview Schedule for Children (DISC) Cannabis Symptoms, which is reported to have a sensitivity of 96% and a specificity of 86% (likelihood ratio of 6.83) and is composed of 1 question. We calculated Cohens to assess interrater reliability. The RSQ, a verbal 4-question suicide screening instrument, Twenty-two percent of patients screened positive on the RSQ. hZkoG+!!E@@ (a02Zga%soUOO{R"'z{[M Ol5 8~pls48_ Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic | Pediatrics | JAMA Network Open | JAMA Network This cohort study examines whether the use of surgical face masks among children was associated with changes in respiratory function or signs of respiratory dis [Skip to Navigation] Most adolescents and parents rated screening for suicide risk and other mental health problems in the ED as important. Adolescents preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors? Study design and risk of bias are presented in Table 1. A systematic review. Oral health risk assessment timing and establishment of the dental home. The developmental milestones are listed by month or year first because well-child visits are organized this way. A 2-question SI screen was piloted by Patel et al50 in an urgent care setting to identify adolescents at risk for SI. Behavioral Health ScreeningEmergency Department, Diagnostic Interview Schedule for Children, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, feedback, responsibility, advice, menu, empathy, self-efficacy, home, education, activities, drugs, sexual activity, suicide and/or mood, screening, brief intervention, and referral to treatment. Our findings outline promising tools for improving screening and intervention, highlighting the critical need for continued development and testing of interventions in these settings to improve adolescent care. They found that the risk of intimate partner violence in female adolescents who presented to the ED was high (37%) and that 4 screening questions had 99% sensitivity.62. The use of standardized screening tools by pediatric providers is more effective in the identification of developmental, behavioral and psychosocial issues in children than clinical assessments alone. Seven studies on substance use screening and intervention were included in our review; all took place in the ED setting (Table 4). PDF The SSHADESS Screening: A Strength-Based Psychosocial Assessment American Academy of Pediatrics Offers Guidance for Caring and Treatment of Long-Term Cancer Survivors Childhood Cancer Survivors: What to Expect After Treatment News Releases Policy Collections Advocacy The State of Children in 2020 Healthy Children Secure Families Strong Communities This IMPACT project analyzes which factors are associated with HEADSS assessment completion and aims . Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines flowchart of study selection. ACA, adaptive conjoint analysis; ACASI, audio-enhanced computer-assisted self-interview; ARA, adolescent relationship abuse; AUDIT-C, Alcohol Use Disorders Identification TestConsumption; AUDIT-PC, Alcohol Use Disorders Identification Test-(Piccinelli) Consumption; AUDIT-3, 3-Item Alcohol Use Disorder Identification Test; AUDIT-10, 10-Item Alcohol Use Disorder Identification Test; BHS, Beck Hopelessness Scale; BIS-11, Barratt Impulsivity Scale; CAGE, Cut down, Annoyed, Guilty, Eye-opener; CDS, clinical decision support; CRAFFT, Car, Relax, Alone, Forget, Friends, Trouble; CSSRS, Columbia Suicide Severity Rating Scale; CT, Chlamydia trachomatis; CTS, Conflict Tactics Survey; DSM5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; EC, emergency contraception; ED-DRS, Emergency Department Distress Response Screener; EPT, expedited partner therapy; ER, emergency department; FAST, Fast Alcohol Screening Test; GC, Neisseria gonorrhoeae; HCP, health care provider; HEADS-ED, Home, Education, Activities and peers, Drugs and alcohol, Suicidality, Emotions and behaviors, Discharge resources; IPV, intimate partner violence; LARC, long-acting reversible contraception; LR+, positive likelihood ratio; NIAAA, National Institute of Alcohol Abuse and Alcoholism; NP, nurse practitioner; NPV, negative predictive value; POSIT, Problem Oriented Screening Instrument for Teenagers; PRI, pregnancy risk index; PTSD, posttraumatic stress disorder; RADS-2, Reynolds Adolescent Depression Screening, Second Edition; RAFFT, Relax, Alone, Friends, Family, Trouble; RAPS4-QF, Remorse, Amnesia/blackouts, Perform, Starter/eye-opener, Quantity, Frequency; RBQ, Reckless Behavior Questionnaire; RUFT-Cut, Riding with a drinking driver, Unable to stop, Family/Friends, Trouble, Cut down; SIQ, Suicidal Ideation Questionnaire; SIQ-JR, Suicidal Ideation Questionnaire Junior; STD, sexually transmitted disease; TWEAK, Tolerance, Worried, Eye-opener, Amnesia, Kut-down . Documentation of reproductive health and inpatient delivery of reproductive health services (STI testing and/or treatment, HPV vaccination, and contraceptive provision), Documentation: Fifty-five percent of patients had sexual history documentation. The American Academy of Pediatrics on Monday recommended that all children over the age of 2 wear masks when returning to school this year, regardless of vaccination status. Scoping reviews map out broad themes and identify knowledge gaps when the published works of focus use a wide variety of study designs.15 We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to inform our search and synthesis of the literature.16. Twenty-five percent never conducted SBIRT (limited time and resources are barriers). Reported barriers were time constraints and limited resources. A patient was more likely to have documentation if the note was written by an intern (, Sexual and menstrual history documentation. Screening and Counseling Adolescents and Young Adults: A - AAFP endstream endobj 323 0 obj <>stream Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. The Ask Suicide Screening Questions (asQ) assesses patients with severe symptoms of depression. Sexual history documentation was incomplete in charts of adolescents discharged from the ED with STI diagnosis. 2010;38(10):746-761; American Academy of Pediatrics Section on Pediatric Dentistry and Oral Health. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. HEADSS UP: Predictors for Completion of Adolescent Psychosocial For example, Shamash et al36 found that the majority of adolescents did not support provision of expedited partner therapy and partner notification if an STI was identified, citing reasons such as the importance of interaction between the partner and his or her own clinician. For cannabis use screening, the authors recommend using the DISC Cannabis Symptoms (1 question): In the past year, how often have you used cannabis: 0 to 1 time, 2 times? For alcohol use screening, the authors recommend using the DSM-IV 2-item scale: In the past year, have you sometimes been under the influence of alcohol in situations where you could have caused an accident or gotten hurt? Have there often been times when you had a lot more to drink than you intended to have?, Reviews epidemiology, screening, and MI and brief interventions for substance use. All students are required to complete an observed HEADSS assessment over the course of their clerkship. We pooled results from both queries together and removed duplicates. Pediatricians are an important first resource for parents and caregivers who are worried about their child's emotional and behavioral health or who want to promote healthy mental development. If your child is alert and responds to you, the head injury is mild and usually no tests or X-rays are needed. Preventive care for adolescents: few get visits and fewer get services, Patterns of primary care physician visits for US adolescents in 2014: implications for vaccination, Adolescent health, confidentiality in healthcare, and communication with parents, Adolescents who use the emergency department as their usual source of care. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. To access log in and visit The RSQ could not be validated in an asymptomatic population of adolescents and was noted to have a high false-positive rate in this low-risk population (recommended doing more general HEADSS screening). Concussions: What Parents Need to Know - HealthyChildren.org Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). Mental health is an essential component of overall health. Adolescents reported interest in receiving education about sexual health topics, such as STIs, contraception, and HIV, in the ED. However, lack of initial physician buy-in and administrative hurdles, such as funding for HPAs, training, and competition with other medical professionals (ie, social workers), made it difficult to transition this intervention into sustainable clinical practice.20 In 2 studies, researchers evaluated physician reminders to screen, including a home, education, activities, drugs, sexual activity, suicide and/or mood (HEADSS) stamp on paper medical charts and a distress response survey in the electronic health record (EHR). Adolescent Risk Behavior Screening and Interventions in the Hospital Setting. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Two studies on abuse and violence screening and intervention were included in our review; both took place in the ED setting (Table 4). PDF Getting into adolescent heads: An essential update - University of Arizona HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. Fein et al49 describe successful implementation of a more broad behavioral health screen: the BHS-ED, which is used to assess for mood and behavioral health issues as well as associated risks, such as substance use. Download Emergency Department ACE form Physician/Clinician office ACE form Acute Concussion Evaluation (ACE) Care Plans ACE (Acute Concussion Evaluation) c are plans help guide a patient's recovery. Self-administered BHS-ED: computerized survey to assess substance use, PTSD, exposure to violence, SI, and depression, During the implementation period, BHS-ED was offered to 33% of patients by clinical staff. Parents were overall supportive of sexual activity screening and care provision in the ED and hospital setting. Adolescents prefer in-person counseling and target education (related to their chief complaint). You can find the latest versions of these browsers at https://browsehappy.com. In the Supplemental Information, we outline the details of our search strategy. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of . Pediatrics. ED clinicians acknowledged the importance of depression screening. By continuing to use our website, you are agreeing to, https://www.cdc.gov/healthyyouth/data/yrbs/index.htm, www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/adolescent-sexual-health/Pages/Assessing-the-Adolescent-Patient.aspx, www.pediatrics.org/cgi/content/full/123/4/e565, www.pediatrics.org/cgi/content/full/122/5/e1113, https://doi.org/10.1097/PEC.0000000000001746, www.pediatrics.org/cgi/content/full/128/1/e180, HEADSS assessmentbased interview conducted by resident physicians, HEADSS-based psychosocial screening by admitting physician, HEADSS stamp placed on patient charts to serve as a visual reminder for ED clinicians to complete psychosocial screening, The HEADSS assessment rate increased from <1% to 9% (, Tablet-based survey to assess risk behaviors, technology use, and desired format for risk behavior interventions, For each category of risk behavior assessed, 73%94% of adolescents (, Youth and Young Adult Health and Safety Needs Survey completed by HPAs. Barriers identified included time, concern about follow-up, and lack of knowledge. We did not combine and quantitatively analyze study results because of heterogeneity in study design. Many adolescents felt the ED should universally provide education on sexual and reproductive health practices and provide contraceptive services, especially for patients who may not have access to a primary provider.25,3032 Chernick et al33 found that one-fourth of the adolescent patients in their study were interested in receiving contraception in the ED. Although comprehensive risk behavior screens (eg, the American Academy of Pediatrics Bright Futures64 and HEADSS3,65) remain the gold standard, they have not been validated in the ED or hospital setting. Risk for pregnancy was high among adolescent patients in the ED, particularly for those with recent ED use and without a primary care provider. Three ED studies described interventions to increase comprehensive risk behavior screening. A significant proportion of adolescents who screened positive for elevated suicide risk in the ED were presenting for nonpsychiatric reasons. This study was determined exempt by the Institutional Review Board at the University of California, San Francisco. The AAP, which said. All rights reserved. *0zx4-BZ8Nv4K,M(WqhQD:4P H!=sb&ua),/(4fn7L b^'Y):(&q$aM83a hdQT Nj'8PHla8K^8nLBs7ltJ2umZi96^p&)PZ?]3^$Zc`O;|462 L-{:ZA:JmGv?Hw(ibKWyK2>{)K_P/)g?\(E~&=wAez8nsM7bvE^#FUTd1"$73;ST\ao=7S[ddf(K$7v |(|w .AFX In retrospective cohort studies by Riese et al,24 McFadden et al,25 and Stowers and Teelin,26 sexual activity screening rates in the hospital setting are described. Learn Steps to Improve the Care of Your Pediatric Patients with mTBI. Two independent reviewers screened, extracted, and summarized the studies (N.P. Only 1.2% used SBIRT consistently. The studies in our review reveal ubiquitously low rates of risk behavior screening in the ED and hospital setting across all risk behavior domains. ED physicians used SBIRT in limited and nonstandardized ways. Marc Olivier: Heads up on Twitter: "RT @nancydoylebrown: David A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. Nineteen studies on sexual activity screening and/or intervention were included in our review: 5 in the hospital setting (Table 3) and 14 in the ED (Table 4). We acknowledge Evans Whitaker, MD, MLIS, for his assistance with the literature search. Although poverty increases the risk for mental health conditions, studies show that the greatest increase in prevalence occurred among children living in households earning greater than 400% above the federal poverty line. Overall risk of bias was as follows: low, 1 variable not present; moderate, 23 variables not present; and high, 45 variables not present. Two of the studies took place in the hospital setting and 4 in the ED setting. All children should wear masks in school this fall, even if vaccinated Similarly, in 2 qualitative studies by Ballard et al,52,53 90% to 96% of interviewed adolescents responded positively to SI screening in the ED. Less than half of admitted patients had documented menstrual (32.8%) or sexual history (45.9%). Comprehensive Adolescent Risk Behavior Screening Studies. Similarly, in a hospital study of surgical adolescent patients by Wilson et al,19 the authors found that only 16% of patients were offered screening, and of these, 30% required interventions. We report on a number of successful domain-specific screening tools validated in ED and hospital settings. Two-thirds of patients surveyed did not prefer EPT and cited reasons such as importance of determining partner STI status, partner safety, partner accountability, and importance of clinical interaction. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? The ASQ is a brief tool to assess suicide risk in pediatric patients in the ED and has a high sensitivity, specificity, and NPV. We developed the rapid screening tool home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED), which is a modification of "HEADS," a mnemonic widely used to obtain a psychosocial . Promising solutions include self-disclosure via electronic screening tools, educational sessions for clinicians, and clinician reminders to complete screening. Positive themes included detection of youth who may be at risk and have a lack of social support as well as possible prevention of suicide attempts. The STI testing frequency (intervention) was higher in the intervention group (52.3% vs 42%; OR 2.0 [95% CI 1.13.8]) and in asymptomatic patients (28.6% vs 8.2%; OR 4.7 [95% CI 1.415.5]). We're 67,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus limiting generalizability. If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. h222W0Pw/+Q0,H/-K-0 = Paper questionnaire to assess sexual activity, pregnancy or desire for pregnancy, interest in receiving sexual health interventions in the ED, and use of health care, Thirteen percent of surveyed adolescents (. The ED-DRS is a short but effective tool in screening for mental health risks and can create an environment in the ED for quick, feasible screening and intervention. Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. Using methods from a study by Rea et al,18 we analyzed risk of bias for each of the included studies and found that only 2of 46 studies had a low risk of bias, 33 of 46 had moderate risk of bias, and 11 of 46 had a high risk of bias. Only 62% of charts had sexual history documented in the admission H&P, and among those patients who did have documentation, 50.5% were found to be sexually active. The goal of the training is to provide an overview of the evidence-based recommendations outlined in the CDC Pediatric mTBI Guideline and to equip healthcare . Six studies met inclusion criteria, and 11 instruments were evaluated (AUDIT, CAGE, CRAFFT, DISC Cannabis Symptoms, DSM-IV 2-item scale, FAST, RAFFT, RAPS4-QF, RBQ, RUFT-Cut, TWEAK). To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. When patients screen positive for risky behaviors, it is imperative to have strategies and resources in place to address these behaviors. Our data sources included PubMed (19652019) and Embase (19472019). Welcome to HEADS-ED. In our review, we found several reports on various SI screening tools in acute care settings, including the Ask Suicide-Screening Questionnaire (ASQ), the Risk of Suicide Questionnaire (RSQ), and the Behavioral Health ScreeningEmergency Department (BHS-ED); these studies indicate the potential promise of these tools and also reveal significant SI risk in adolescents presenting for nonpsychiatric issues. Details on risk level were frequently left out. We excluded studies that involved outpatient follow-up of patients to evaluate interventions that could be completed in the ED or hospital setting, but this may have limited our review of more longitudinal effects. Adolescents expressed that screening could lead to identification, prevention, and treatment of suicidal thoughts and/or behavior as well as provide an opportunity to connect with the nurse for those who lack other sources of support. The HEADSSS assessment is an internationally recognised tool used to structure the assessment of an adolescent patient, encompassing H ome, E ducation/ E mployment, A ctivities, D rugs, S ex and relationships, S elf harm and depression, S afety and abuse. Eighty-two percent of patients who screened positively were referred to outpatient mental health, and 10% were admitted to a psychiatric facility. With the COVID-19 pandemic, this activity . Computer-based interventions for adolescents who screen positive for ARA, as well as universal education in the form of wallet-sized cards, are promising and could be successful in the ED setting. The value of such interaction was echoed in another study in which patients preferred in-person counseling.37 However, in a cross-sectional hospital study, Guss et al38 found that patients who were interested in more information preferred learning about contraceptive options from a brochure rather than from a clinician. PDF Mental Health Tools for Pediatrics - AAP The HEADSS Assessment: A Virtual Psychosocial Interview for - AAMC Screening Tools: Pediatric Mental Health Minute Series, Standardized Screening/Testing Coding Fact Sheet for Primary Care Pediatricians: Developmental/Emotional/Behavioral, Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening, Promoting Optimal Development: Screening for Behavioral and Emotional Problems, Recommendations for Preventive Pediatric Health Care, Substance Use Screening, Brief Intervention, and Referral to Treatment, Addressing Mental Health Concerns in Primary Care: A Clinicians Toolkit American Academy of Pediatrics, Links to Commonly Used Screening Instruments and Tools, Long-term Follow-up Care for Childhood, Adolescent and Young Adult Cancer Survivors, Roadmap for Care of Cancer Survivors: Joint Report Updates Recommendations, American Academy of Pediatrics Offers Guidance for Caring and Treatment of Long-Term Cancer Survivors, Childhood Cancer Survivors: What to Expect After Treatment, Transition Plan: Advancing Child Health in the Biden-Harris Administration, Childrens Health Care Coverage Fact Sheets, Prep- Pediatric Review and Education Programs. The American Academy of Pediatrics (AAP) recommends screening all children for ASD at the 18 and 24-month well-child visits in addition to regular developmental surveillance and screening.