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. Pediatrics. Barriers identified included time, concern about follow-up, and lack of knowledge. In 75% of cases in which risk behaviors were identified, interventions were provided. 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. Almost all patients deemed to have elevated suicide risk endorsed SI (SIQ-JR) and/or had a recent suicide attempt. There is a high unintended pregnancy risk in adolescents using the ED. Adolescents reported interest in receiving education about sexual health topics, such as STIs, contraception, and HIV, in the ED. 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.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 clinician during the visit to address risk behaviors.7,8 Screening for risk behaviors confidentially is crucial to disclosure of engagement in risky behavior and also increases future likelihood of patients seeking preventive care and treatment.9 An estimated 1.5 million adolescents in the United States use EDs as their main source of health care,10 and these adolescents are more likely to come from vulnerable and at-risk populations.11 Additionally, risky behaviors and mental health disorders are prevalent among teenagers with chronic illnesses, a group that accounts for a significant proportion of hospitalized adolescents.1214 These findings underscore the need to perform risk behavior screening and interventions, such as STI testing and treatment, motivational interviewing (MI), and contraception provision, in ED and hospital settings. IMPACT Program | Children's Hospital Los Angeles Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. 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). Buy-in from physicians was difficult in the implementation phase. hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd The ASQ is a brief tool to assess suicide risk in pediatric patients in the ED and has a high sensitivity, specificity, and NPV. All rights reserved. Most adolescents and parents rated screening for suicide risk and other mental health problems in the ED as important. 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. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . Our findings can help guide efforts in these settings to advance screening and interventions for risk behaviors, thereby improving health outcomes for adolescents. In the Supplemental Information, we outline the details of our search strategy. Three ED studies described interventions to increase comprehensive risk behavior screening. Investigates different SI screening tools used in ED. ED clinicians acknowledged the importance of depression screening. They described targeted computer modules as interventions for adolescents who screen positive or, alternatively, use of a universal education intervention, such as a wallet-sized informational card. Survey of 17 candidate suicide screening questions. Twenty-five percent never conducted SBIRT (limited time and resources are barriers). The ED is an opportunity to screen adolescents for SI, and there are numerous (although some not validated in a hospital setting) tools that can be used for screening despite no consistent recommendations for universal screening. 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. 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. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. Four screening questions identified 99% of patients who had experienced IPV. *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 Current Concepts in Concussion: Initial Evaluation and Management 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. For more educational content visitwww.pedialink.org. Semistructured focus groups covering thoughts and experience with EC; written survey to assess EC knowledge. A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. Your Preemie's Growth & Developmental Milestones The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. The Ask Suicide Screening Questions (asQ) assesses patients with severe symptoms of depression. 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. In the full-text screen, both reviewers included 43 studies and excluded 25 studies; 7 studies were in conflict. 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). Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. ED physicians used SBIRT in limited and nonstandardized ways. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. 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). If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. ED physicians and NPs were more likely than nurses to support providing adolescents with EC, but most did not agree with routine screening for EC need in the ED. One study that met inclusion criteria was found post hoc and included in the final review for a total of 46 studies (Fig 1). Headache is the most common symptom. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. No documentation of sex of partners, partners STI risk, partners drug use, anal sex practice, or use of contraception other than condoms was found in charts reviewed. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. Preventive oral health intervention for pediatricians. However, rates of e-cigarette and similar device use among youth are high, and rates of other tobacco product use, such as cigars and hookahs, have not declined. Data sources included PubMed (19652019) and Embase (19472019). PDF Getting into adolescent heads: An essential update - University of Arizona We outline potential tools and approaches for improving adherence to guideline-recommended comprehensive screening and adolescent health outcomes. Six-five percent agreed to screening (. The NIAAA 2-question screen is a valid and brief way to screen for alcohol use in pediatric EDs. 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. 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. 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. Of those who ended up needing it, 92% had answered yes before knowing. For anything more than a light bump on the head, you should call your child's doctor. Screening for Social Determinants of Health Among Children and Families Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. More prospective controlled studies are needed to evaluate such interventions in ED and hospital settings. Further research is needed to assess the effectiveness of the CDS system in improving adolescent sexual health care. The Newton Screen may be a good brief screening tool for assessing alcohol and cannabis use. We conducted a literature search in June 2019. 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. These funders played no role in the study design, analysis, or preparation of this article. Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent? Promising methods to increase screening rates include self-disclosure electronic screening tools coupled with reminders for clinicians (paper or within the EHR). Female adolescents showed preference for in-person counseling, from a person of authority (doctor, nurse) rather than from a peer counselor. 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. SI screening of all patients in the ED is feasible and acceptable to adolescent patients. The developmental milestones are listed by month or year first because well-child visits are organized this way. The DISC Cannabis Symptoms was reported to have a sensitivity of 96%, a specificity of 86%, and an LR+ of 6.83. The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. A patient was more likely to have documentation if the note was written by an intern (, Sexual and menstrual history documentation. 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. 2003; 122(6):1387-1394; and American Academy of Pediatrics Section of Pediatric Dentistry. MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. 13-20% of children in the U.S. experience a mental health disorder each year. A computerized psychosocial screening tool, such as the BHS-ED, may be a feasible intervention to increase detection of mental health problems in adolescent patients in the ED. 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 CSSRS has been validated in multiple settings (including the ED and inpatient setting in patients with mental health problems). A significant percentage of sexually active adolescents surveyed were potential candidates for EC. 10.1542/peds.2020-020610. 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. Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. Your child's doctor will want to know when and how the injury happened and how your child is feeling. 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. The HEADS-ED: a rapid mental health screening tool for - PubMed of Items and Format Age-group and Any Languages / Reading Level if Specified Administration and Scoring Time Training a Source Initial Psychosocial Assessment (Algorithm Step 2): Previsit or Intra -visit Data Collection and Screening Surveillance The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. .Z\S(?CvRx(6?X8TTnY-k!/.~zNV?-.,/O]b1:z>=Z.