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]). Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? 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 Geopolitical boundaries do not circumscribe health issues and nowhere is this more obvious than in Los Angeles. In the full-text screen, both reviewers included 43 studies and excluded 25 studies; 7 studies were in conflict. hZkoG+!!E@@ (a02Zga%soUOO{R"'z{[M Ol5 8~pls48_ 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). 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. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. 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 . FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. Revisions: 7. 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 In several studies, researchers found that computerized self-disclosure tools were preferred by adolescent patients, regardless of the presenting chief complaint.34,35 Regarding counseling and interventions, adolescent patients generally valued clinician-patient interactions. 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). These funders played no role in the study design, analysis, or preparation of this article. 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. Most adolescents have few physical health problems, so their medical issues come from risky behaviors. A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. To help identify such patients, a cross-sectional study done to validate the RSQ in patients presenting to the ED revealed a clinically significant prevalence (5.7%) of SI in patients with nonpsychiatric chief complaints.46 However, another validation study revealed that in a low-risk, nonsymptomatic patient population, the RSQ had high false-positive rates. More prospective controlled studies are needed to evaluate such interventions in ED and hospital settings. 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 (. Pain assessment is an integral component of the dental history and comprehensive evaluation. Survey to assess acceptability of sexual health discussion, STI testing, and pregnancy testing in the ED; verbal explanation of answers also obtained from participants. Seven studies on substance use screening and intervention were included in our review; all took place in the ED setting (Table 4). Patient-administered 22- to 27-item survey on attitudes toward inpatient reproductive health screening and interventions. Of those who ended up needing it, 92% had answered yes before knowing. Review of instruments used to assess alcohol and other drug use in pediatric patients in the ED (published in 2011; included studies published in 20002009). FUNDING: Dr Kaiser is supported by grants from the Agency for Healthcare Research and Quality (K08HS024592 and R03HS027041). 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. h222W0Pw/+Q0,H/-K-0 = Further study of technology-based behavioral interventions is warranted. HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. programs for many years.3The rationale behind the modification includes It begins with strengths. RCT, randomized controlled trial; , not present; +, present. Copyright American Academy of Pediatrics. 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. Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI. 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. When implementing an alcohol use screening and/or intervention program for adolescents in the ED, it is important to minimize workflow disruption caused by the program and provide adequate education to achieve staff participation. Survey of female adolescent patients using ACA software. When symptoms or signs of orofacial/dental pain are evident, a detailed pain assessment helps the dentist to derive a clinical diagnosis, develop a prioritized treatment plan, and better estimate anal- gesic requirements for the patient. It appears you are using Internet Explorer as your web browser. 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] Welcome to HEADS-ED. 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 . 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?. All rights reserved. Buy-in from physicians was difficult in the implementation phase. Interview, primary question of interest: Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. Dr Pfaff conceptualized and designed the study, conducted the literature search, screened literature for inclusion, extracted data from included studies, and drafted and edited the manuscript; Dr DaSilva helped in study design, conducted the literature search, screened literature for inclusion, extracted data, and helped with drafting the original manuscript; Dr Ozer helped in study design, editing and revising the manuscript, and critically appraising the manuscript content; Dr Kaiser supervised the conceptualization and design of the study, supervised the data extraction from the included literature, and helped in revising and editing the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Oral health risk assessment timing and establishment of the dental home. 10.1542/peds.2020-020610. 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. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. This demonstrates that we do not viewyouth only in the risk context. We described and summarized major findings, organized by the following risk behavior categories: comprehensive, sexual activity, mood and suicidal ideation (SI), substance use, and abuse and violence. Details on risk level were frequently left out. Please note, Internet Explorer is no longer up-to-date and can cause problems in how this website functionsThis site functions best using the latest versions of any of the following browsers: Edge, Firefox, Chrome, Opera, or Safari. 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. SI screening of all patients in the ED is feasible and acceptable to adolescent patients. Survey of 17 candidate suicide screening questions. 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. For more educational content visitwww.pedialink.org. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines flowchart of study selection. Mental health is an essential component of overall health. 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. Pediatrics April 2021; 147 (4): e2020020610. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . A significant proportion of adolescents were interested in starting contraception in the ED. Most clinicians agreed that computerized depression screening could be a suitable approach to address many of the identified barriers to screening. Four screening questions identified 99% of patients who had experienced IPV. Within each category, we grouped studies by subcategory: screening rates, screening and intervention tools, and attitudes toward screening and intervention. Patients and clinicians are generally receptive to screening in these settings, with barriers including adolescents privacy concerns, clinicians time constraints, and clinicians comfort and knowledge with risk behavior screening and risk behavior interventions. 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. The HEEADSSS interview is a practical, time-tested, complementary strategy that physicians can use to build on and incorporate the guidelines into their busy office practices. The FRAMES acronym tool can be used to outline brief interventions. In a qualitative study, researchers assessed ED physician use of screening, brief intervention, and referral to treatment (SBIRT) and found that <50% of respondents used a validated tool when screening for alcohol use.60 Common perceived barriers were time constraints, inadequate staffing, lack of knowledge of screens, and concerns about parents reactions to screening. and A.D.). Adolescents expressed that screening could lead to identification, prevention, and treatment of suicidal behavior. The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. Adolescents prefer in-person counseling and target education (related to their chief complaint). Headache is the most common symptom. 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. Preventive oral health intervention for pediatricians. 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. The DISC Cannabis Symptoms was reported to have a sensitivity of 96%, a specificity of 86%, and an LR+ of 6.83. An additional 28% had partial or incomplete screening, with less sensitive issues, such as home life, education, and employment, documented significantly more often than sexual activity, depression, or drug use (P = .013). This IMPACT project analyzes which factors are associated with HEADSS assessment completion and aims . 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. 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. 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. The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. 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). Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). For anything more than a light bump on the head, you should call your child's doctor. screening1,2 responsible adult is a modified HEADSSscreening, which has toask the rightbeentaught in adolescent medicine and pediatric training questions. 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. Parents were overall supportive of sexual activity screening and care provision in the ED and hospital setting. Also, most studies had limited durations of follow-up, so we cannot comment on long-term effects. Adolescent Risk Behavior Screening and Interventions in the Hospital Setting. 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. Further research is needed to assess the effectiveness of the CDS system in improving adolescent sexual health care. A 2-question SI screen was piloted by Patel et al50 in an urgent care setting to identify adolescents at risk for SI. Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. Download ACE Care Plan - Work version ACE Care Plan - School version Sexual activity self-disclosure tool (ACASI). 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?. We first screened titles and abstracts using Rayyan software (Qatar Computing Research Institute, Doha, Qatar),17 and we resolved conflicts regarding the title and abstract screen through discussion. Our study also highlights the general dearth of studies on the topic (only 7 studies in the hospital setting, only 2 studies with low risk of bias based on our analysis). However, many barriers to screening in the ED setting were reported. MI and brief intervention are effective methods to address high-risk behaviors. 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. ED and Urgent Care Adolescent Risk Behavior Screening and Interventions. Pediatrics. 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. High risk for SI was identified in 93.4% of yes respondents and in 84.5% of the no response group. Cohens was calculated and determined to be 0.8, correlating with a 90.7% agreement. In the ED, researchers of a single-blind randomized controlled trial tested a computerized self-administered screening tool to identify adolescent patients who were at risk for STIs. 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).
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