Written surveys: RADS-2, SIQ-JR, AUDIT-3, POSIT, BHS, and BIS-11; positive suicide risk screen result defined as follows: (1) positive SIQ-JR result or recent suicide attempt or (2) positive AUDIT-3 and RADS-2 results. You can find the latest versions of these browsers at https://browsehappy.com. 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. Completely updated and revised for new diagnostic criteria, this toolkit provides practical guidance and fillable forms to help you turn your practice into a medical home for children with ADHD. A model of 4 candidate questions (ASQ) was found to have a sensitivity of 96.9%, a specificity of 87.6%, and an NPV of 99.7%. 2010;38(10):746-761; American Academy of Pediatrics Section on Pediatric Dentistry and Oral Health. Of those, 47% endorsed sexual activity. To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. In 75% of cases in which risk behaviors were identified, interventions were provided. It is important to conduct adolescent substance use screening in the ED. Screening in the urgent care setting helped identify adolescents at risk for SI, most of whom did not have mental healthrelated chief complaints, and this led to interventions in the form of referrals or urgent admission. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. Audit of sexual activity and risk-level status documentation. PDF The SSHADESS Screening: A Strength-Based Psychosocial Assessment The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. Questionnaire used to assess beliefs regarding screening and intervention for suicide risk and other mental health problems in the ED. A patient was more likely to have documentation if the note was written by an intern (, Sexual and menstrual history documentation. The ASQ has been widely referenced in literature as a brief and feasible tool to assess suicide risk in pediatric patients in the ED.43 The ASQ 4-question screen has a sensitivity of 96.9%, a specificity of 87.6%, and a negative predictive value of 99.7%.44 In their review, King et al45 found that universal screening for mood and SI in the ED setting can identify a clinically significant number of patients who have active SI but are presenting for unrelated medical reasons. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. Two of the studies took place in the hospital setting and 4 in the ED setting. Reported barriers were time constraints and limited resources. 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 American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Interview, primary question of interest: Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. A majority of participants (85%) felt the ED should provide information on contraception, and 65% believed the ED should provide safe sex and pregnancy prevention services at all ED visits. Almost all adolescents agreed that nurses should screen for suicide risk in the ED. Screening and Counseling Adolescents and Young Adults: A - AAFP EC knowledge was poor among clinicians surveyed. h222W0Pw/+Q0,H/-K-0 = The Vanderbilt rating scale assesses symptoms of attention deficit disorder as well as oppositional and anxious behaviors. Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. The Newton Screen had better sensitivity for cannabis use and good specificity for both. Address correspondence to Nora Pfaff, MD, Department of Pediatrics, University of California, San Francisco Benioff Childrens Hospital, 550 16th St, 5th Floor, San Francisco, CA 94143. 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 . Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth, Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review, The role of motivational interviewing in children and adolescents in pediatric care. Web-based questionnaire on pregnancy risk. The shorter versions of AUDIT (AUDIT-C and AUDIT-PC) failed to identify a significant proportion of adolescents with a positive AUDIT-10 result. IMPACT Program | Children's Hospital Los Angeles 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. Within each category, we grouped studies by subcategory: screening rates, screening and intervention tools, and attitudes toward screening and intervention. In the hospital setting, the top 3 barriers to sexual activity screening among clinicians included concerns about follow-up (63%), lack of knowledge regarding contraception (59%), and time constraints (53%). Adolescents prefer in-person counseling and target education (related to their chief complaint). The HEADSS stamp resulted in a significant increase in postintervention screening rates (from <1% to 9%; P = .003).21 The EHR distress response survey by Nager et al22 was found to be feasible to integrate into the busy ED physician workflow, but the study offered limited insight into effects on screening or utility of the tool (assessed by using only yes or no questions). The studies in our review reveal ubiquitously low rates of risk behavior screening in the ED and hospital setting across all risk behavior domains. 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. Three ED studies described interventions to increase comprehensive risk behavior screening. Preventive oral health intervention for pediatricians. A limitation of this scoping review is heterogeneity in the design and quality of the included studies, with only 1 randomized controlled trial in our area of focus. The experiences and opportunities offered in early childhood lay the foundation for how children grow, learn, build relationships, and prepare for school. The purpose of this exercise is to provide medical students an opportunity to practice their skills performing a HEADSS assessment with an adolescent standardized patient through video conferencing. Further study of technology-based behavioral interventions is warranted. All students are required to complete an observed HEADSS assessment over the course of their clerkship. ED physicians used SBIRT in limited and nonstandardized ways. In several ED studies, authors cited concerns from clinicians that the ED was not the appropriate setting to address sexual activity, particularly if it was not related to the patients presenting problem.39,41 Clinicians in the ED setting had a preference for computerized screening tools as well.42. The biggest concerns from adolescent patients included worries about privacy issues.51, Parental reservations regarding screening were focused on the patient being in too much pain or distress for screening.46 Other identified hesitations were fear of a lack of focus on nonpsychiatric chief complaints and possible iatrogenic harm secondary to screening.53, Clinicians felt that a computerized depression screen would overcome many of the identified barriers (lack of rapport, time constraints, high patient acuity, lack of training or comfort, privacy concerns, and uncertainty with next steps), but they endorsed a need for support to facilitate connecting patients with mental health resources and interventions.54. Protecting Children and Adolescents From Tobacco and Nicotine In fact, in a study by Miller et al,39 parents were more accepting of sexual activity screening and STI testing than surveyed clinicians. Head Injury in Children: How to Know If It's Minor or Serious 2022 PREP The Curriculum - AAP Sexual history documentation was incomplete in charts of adolescents discharged from the ED with STI diagnosis. 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). PDF Mental Health Tools for Pediatrics - AAP The AAP, which said. Our data sources included PubMed (19652019) and Embase (19472019). Previous studies indicate low rates of risk behavior screening and interventions in ED and hospital settings. Current Concepts in Concussion: Initial Evaluation and Management This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . Teenagers report wanting to receive pregnancy and STI preventive care in the ED, regardless of the reason to visit. We only included studies published in English. RCT, randomized controlled trial; , not present; +, present. Overall risk of bias was as follows: low, 1 variable not present; moderate, 23 variables not present; and high, 45 variables not present. Risk for pregnancy was high among adolescent patients in the ED, particularly for those with recent ED use and without a primary care provider. Moderate to good test-retest reliability was found between questionnaire takers. In this study, the terms hospitalized or hospital setting refer to patients admitted to pediatric units under either inpatient or observation status. Most clinicians agreed that computerized depression screening could be a suitable approach to address many of the identified barriers to screening. With the heterogeneity of studies included, we could only summarize findings but could not perform a meta-analysis. endstream endobj 322 0 obj <>stream Of respondents, 76.5% preferred an electronic survey to face-to-face interviews. There were no studies on patient or parent attitudes toward substance use screening or interventions. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). As physicians, we need to ask about the context of a teen's life, and the HEADSS assessment is a good guide. Further study is warranted. 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. 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. The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. A concussion is a type of traumatic brain injury (TBI) that temporarily disrupts normal brain function. 1 HEADSS is an acronym for the topics that the physician wants to be sure to cover: home, education (ie, school), activities/employment, drugs, suicidality, and sex. The AAP designates this enduring material for a maximum of 40.00 AMA PRA Category 1 Credit (s). The Ask Suicide Screening Questions (asQ) assesses patients with severe symptoms of depression. Yeo et al13 found that 10% of admitted patients at a tertiary childrens hospital had a comprehensive risk behavior assessment documented (defined as 5 of 7 domains: home, education, activities, tobacco use, drug and/or alcohol use, sexual activity, suicide and/or depression). Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. Early childhood is a pivotal period of child development that begins before birth through age 8. Documentation of sexual history in hospitalized adolescents on the general pediatrics service, Addressing reproductive health in hospitalized adolescents-a missed opportunity, Documentation of sexual and menstrual histories for adolescent patients in the inpatient setting, Sexual-history taking in the pediatric emergency department, A computerized sexual health survey improves testing for sexually transmitted infection in a pediatric emergency department, Brief behavioral intervention to improve adolescent sexual health: a feasibility study in the emergency department, Examining the role of the pediatric emergency department in reducing unintended adolescent pregnancy, A pilot study to assess candidacy for emergency contraception and interest in sexual health education in a pediatric emergency department population, Factors associated with interest in same-day contraception initiation among females in the pediatric emergency department, Identifying adolescent females at high risk of pregnancy in a pediatric emergency department, Characteristics of youth agreeing to electronic sexually transmitted infection risk assessment in the emergency department, Development of a sexual health screening tool for adolescent emergency department patients, Preferences for expedited partner therapy among adolescents in an urban pediatric emergency department: a mixed-methods study [published online ahead of print March 14, 2019], Developing emergency department-based education about emergency contraception: adolescent preferences, Using the hospital as a venue for reproductive health interventions: a survey of hospitalized adolescents, Acceptability of sexual health discussion and testing in the pediatric acute care setting, Adolescent reproductive health care: views and practices of pediatric hospitalists, Pediatric emergency health care providers knowledge, attitudes, and experiences regarding emergency contraception, Development of a novel computerized clinical decision support system to improve adolescent sexual health care provision, Utility of the no response option in detecting youth suicide risk in the pediatric emergency department, Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department, Adolescent suicide risk screening in the emergency department. Immediate intervention in the ED and receiving information for follow-up care were rated as the most helpful responses to a positive screening result. Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. Cohens was calculated and determined to be 0.8, correlating with a 90.7% agreement. Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. 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. Confidentiality, consent, and caring for the adolescent patient, Digital health technology to enhance adolescent and young adult clinical preventive services: affordances and challenges, Copyright 2021 by the American Academy of Pediatrics, This site uses cookies. Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! Most adolescents and parents rated screening for suicide risk and other mental health problems in the ED as important. .Z\S(?CvRx(6?X8TTnY-k!/.~zNV?-.,/O]b1:z>=Z. HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. Included studies were published between 2004 and 2019, and the majority (n = 38) of the studies took place in the ED setting, whereas 7 took place in the hospital setting, and only 1 took place in the urgent care setting. Studies were included on the basis of population (adolescents aged 1025 years), topic (risk behavior screening or intervention), and setting (urgent care, ED, or hospital). The Sexual Health Screen reported on by Goyal et al35 presents a feasible and valid way to screen for sexual and reproductive health. Details on risk level were frequently left out. The questions that accounted for the false-positives on the RSQ were the following: Has something very stressful happened to you in the past few weeks? and Have you ever tried to hurt yourself in the past?. Twelve studies on mood and SI screening and intervention were included in our review; 11 took place in the ED setting, and 1 took place in the urgent care setting (Table 4). MI has been demonstrated to be feasible, effective, and a preferred method to change risky behavior across all risk behavior domains in ED and hospital settings.29,59,67 Specifically, the FRAMES acronym provides a promising framework for MI for adolescent substance use but can be applied to any high-risk behavior change.59 However, some adolescents may instead prefer paper materials or brochures over face-to-face counseling, so this presents an alternative option.38 As demonstrated in the McFadden et al25 study, other interventions to consider implementing in the ED and hospital settings include STI testing and treatment, contraceptive provision, HPV vaccination, and referral to subspecialty resources (both inpatient and outpatient). PDF Oral Health Risk Assessment Tool - AAP In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. For more educational content visitwww.pedialink.org. Dr Ozer is supported by grants from the Health Resources and Services Administration of the US Department of Health and Human Services and the Maternal and Child Health Bureau under cooperative agreement UA6MC27378 and Maternal and Child Health Bureau Leadership Education in Adolescent Health Training grant T71MC00003. Data extracted from the full texts included the full citation, study type, risk of bias, risk behavior domain, intervention or screening tool, results of the study, and conclusions. The HEADSS Assessment: A Virtual Psychosocial Interview for - AAMC The ACE (Acute Concussion Evaluation) forms are patient assessment tools. Screening for Social Determinants of Health Among Children and Families Survey of 17 candidate suicide screening questions. MI and brief intervention are effective methods to address high-risk behaviors. ED and hospital encounters present a missed opportunity for increasing risk behavior screening and care provision for adolescent patients; current rates of screening and intervention are low. An MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. Survey of female adolescent patients using ACA software. hZkoG+!!E@@ (a02Zga%soUOO{R"'z{[M Ol5 8~pls48_ 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. Examples of secondary screening tools are, Mental Health Tools for PediatricsScreening TimeStandardized 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 ScreeningPromoting Optimal Development: Screening for Behavioral and Emotional ProblemsRecommendations for Preventive Pediatric Health CareSubstance Use Screening, Brief Intervention, and Referral to Treatment(Policy Statement), Addressing Mental Health Concerns in Primary Care: A Clinicians Toolkit American Academy of PediatricsLinks to Commonly Used Screening Instruments and ToolsAAP Mental Health websiteBright Futures, American Academy of Child and Adolescent Psychiatry. 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). FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. Adolescents in the intervention group were more likely to receive STI testing compared with those in the control arm (52.3% vs 42%; odds ratio [OR] 2.0 [95% confidence interval (CI) 1.13.8]). Sexual activity self-disclosure tool (ACASI). For mood and SI screening, validated tools include the ASQ and RSQ.48,53 For substance use screening, potential tools include the Newton Screen, the National Institute of Alcohol Abuse and Alcoholism 2-question screen, and SBIRT.56,58,66 For intimate partner violence screening, Erickson et al62 validated the 8-item Conflict Tactics Survey. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. 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. Your Preemie's Growth & Developmental Milestones A computerized self-disclosure tool is a feasible way to collect sensitive adolescent data, and adolescents prefer self-disclosure methods and were willing to disclose sexual activity behaviors and receive STI testing, regardless of the chief complaint.
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