We review studies in which rates of risk behavior screening, specific risk behavior screening and intervention tools, and attitudes toward screening and intervention were reported. 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. MI avoids confrontation, and the authors note that both of these evidence-based tools work with a patients readiness to change and build awareness of the problem, resulting in increased self-efficacy for the adolescent.59. Download ACE Care Plan - Work version ACE Care Plan - School version Four screening questions identified 99% of patients who had experienced IPV. The ED visit may provide an opportunity to meet the contraceptive needs of adolescents, particularly for those who do not receive regular well care. A significant proportion of adolescents were interested in starting contraception in the ED. Cohens was calculated and determined to be 0.8, correlating with a 90.7% agreement. When patients screen positive for risky behaviors, it is imperative to have strategies and resources in place to address these behaviors. 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. Sexual activity self-disclosure tool (ACASI). Inclusion criteria were study population age (adolescents aged 1025 years), topic (risk behavior screening or risk behavior interventions), and setting (urgent care, ED, or hospital). Revisions: 7. A systematic review. Less than half of admitted patients had documented menstrual (32.8%) or sexual history (45.9%). This fast movement can cause the brain to bounce around or twist in the skull, creating . Investigates different SI screening tools used in ED. The elements of sexual history most frequently documented were sexual activity (94%), condom use (48%), history of STIs (38%), number of sexual partners (19%), and age at first intercourse (7%). HEADS UP to Healthcare Providers is a free online training developed by CDC and the American Academy of Pediatrics. The Newton Screen may be a good brief screening tool for assessing alcohol and cannabis use. Clinicians were comparatively less accepting, particularly if the visit was not related to sexual health. Of those, 47% endorsed sexual activity. High risk for SI was identified in 93.4% of yes respondents and in 84.5% of the no response group. There are limited studies on ARA screening and intervention in the ED setting; however, successful brief interventions from the outpatient setting could be feasibly implemented in the ED. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Bernstein et al20 used nonphysician providers, or health promotion advocates (HPAs), to perform risk behavior screening and were successful in standardizing comprehensive screening and intervention for adolescents in a busy ED setting by having a dedicated role for the task. Oral health risk assessment timing and establishment of the dental home. All students are required to complete an observed HEADSS assessment over the course of their clerkship. In the United States, young adults are the age group least likely to receive preventive care services, despite improvements in access to care through the Affordable Care Act. endstream endobj 322 0 obj <>stream Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? The experiences and opportunities offered in early childhood lay the foundation for how children grow, learn, build relationships, and prepare for school. 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. 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. programs for many years.3The rationale behind the modification includes It begins with strengths. Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. However, many barriers to screening in the ED setting were reported. It's caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth inside the skull. Study design and risk of bias are presented in Table 1. For an initial psychosocial assessment consider administering a general screening tool such as the Pediatric Symptom Checklist-17 or the Strengths and Difficulties questionnaire, Secondary screening tools are designed to focus on a specific set of symptoms. More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. 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]). One of the best qualities of the HEEADSSS approach is that it proceeds naturally from expected and less threatening questions to more personal and intrusive questions. In fact, in a study by Miller et al,39 parents were more accepting of sexual activity screening and STI testing than surveyed clinicians. Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. We acknowledge Evans Whitaker, MD, MLIS, for his assistance with the literature search. The RSQ, a verbal 4-question suicide screening instrument, Twenty-two percent of patients screened positive on the RSQ. 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 only included studies published in English. Fifty-seven percent of female adolescents answered that adolescents should be offered contraception in the inpatient setting (no significant difference in response between self-reported sexually active and nonactive patients). 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. 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. Survey eliciting sexual history, preferences for partner STI notification, and partner EPT. Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. Survey to assess acceptability of sexual health discussion, STI testing, and pregnancy testing in the ED; verbal explanation of answers also obtained from participants. The 2 reviewers made joint final decisions on inclusion of studies with conflicting initial determinations. 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). For intimate partner violence and adolescent relationship abuse, Jackson et al63 outline successful outpatient interventions (eg, universal wallet-sized educational cards and targeted computerized interventions) that could be feasible in the ED setting but would require further investigation. 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. The majority of respondents reported they would be more likely to increase delivery of sexual health services if provided with further education.40 Clinicians expressed concerns about the acute nature of illness and injury in the ED and the sensitive nature of sexual activity screening. The American Academy of Pediatrics recommends that clinicians screen adolescents for substance use and, if applicable, provide a brief intervention, establish follow-up, and consider referral. Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. 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. 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. 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. As physicians, we need to ask about the context of a teen's life, and the HEADSS assessment is a good guide. 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. For a preterm baby, it is important to use the baby's adjusted age when tracking development until 2 years of age so that his growth and progress take into account that he was born early. More prospective controlled studies are needed to evaluate such interventions in ED and hospital settings. 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. All rights reserved. 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. We conducted a scoping review given expected heterogeneity of the body of literature on this topic. 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. hZkoG+!!E@@ (a02Zga%soUOO{R"'z{[M Ol5 8~pls48_ Interview, primary question of interest (asked after standardized suicide screening): Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. 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. For COVID related questions, please emailcovid-19@aap.org.For Mental Health related questions, please emailmentalhealth@aap.org.Brought to you by AAP Education. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines flowchart of study selection. Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (10%) but significant increases with clinician reminder implementation. ED clinicians acknowledged the importance of depression screening. Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. Four screening questions can capture patients at risk for IPV: Have you felt unsafe in past relationships? Is there a partner from a previous relationship that is making you feel unsafe now? Have you been physically hit, kicked, shoved, slapped, pushed, scratched, bitten, or otherwise hurt by your boyfriend or dating partner when they were angry? Have you ever been hurt by a dating partner to the point where it left a mark or bruise?, Narrative review to explore ARA identification and intervention in the ED. Survey of female adolescent patients using ACA software. Teen preferences for clinic-based behavior screens: who, where, when, and how? 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). 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. Reported barriers were time constraints and limited resources. ED-DRS, Emergency Department Distress Response Screener. Only 1.2% used SBIRT consistently. Fewer than half of respondents used a validated tool when screening for alcohol use. In a narrative review by Jackson et al63 on adolescent relationship abuse screening and interventions in the ED, the authors described successful outpatient interventions that could be easily adapted for the ED setting. With the heterogeneity of studies included, we could only summarize findings but could not perform a meta-analysis. Promising solutions include self-disclosure via electronic screening tools, educational sessions for clinicians, and clinician reminders to complete screening. A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. Of respondents, 76.5% preferred an electronic survey to face-to-face interviews. Universal screening reduces missed opportunities to identify children who may have mental health conditions and promotes intervention aimed at preventing some of the long-term effects of a childhood mental disorder. Guidance for authors when choosing between a systematic or scoping review approach, PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation, Rayyan-a web and mobile app for systematic reviews, Families experiences with pediatric family-centered rounds: a systematic review, Opportunistic adolescent health screening of surgical inpatients, Reaching adolescents for prevention: the role of pediatric emergency department health promotion advocates, Raising our HEADSS: adolescent psychosocial documentation in the emergency department, Mental health screening among adolescents and young adults in the emergency department. A 2-question SI screen was piloted by Patel et al50 in an urgent care setting to identify adolescents at risk for SI. Documentation of sexual activity screening of adolescents was low in both ED and hospital settings. 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 To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. The ASQ is a brief tool to assess suicide risk in pediatric patients in the ED and has a high sensitivity, specificity, and NPV. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. endstream endobj 323 0 obj <>stream 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. Geopolitical boundaries do not circumscribe health issues and nowhere is this more obvious than in Los Angeles. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. Abstract. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). Pediatrics. Promising methods to increase screening rates include self-disclosure electronic screening tools coupled with reminders for clinicians (paper or within the EHR). Web-based questionnaire on pregnancy risk. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of . There was no difference in the median length of ED stay between those who completed the survey and those who did not. The authors reported screening rates of 55% to 62%.24,25 For patients who had documented sexual or reproductive history, screening for more specific risk behaviors (such as condom use, birth control use, and number of sexual partners) was often omitted.24, Similarly, in the ED, a retrospective study by Beckmann and Melzer-Lange27 reported that even in charts of patients diagnosed with an STI, documentation of sexual activity was incomplete and inconsistent. 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). 13-20% of children in the U.S. experience a mental health disorder each year. There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. 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). 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. A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. 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. Pediatrics. Adolescents preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors? 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 .
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