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. 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. Marc Olivier: Heads up on Twitter: "RT @nancydoylebrown: David Seven studies on substance use screening and intervention were included in our review; all took place in the ED setting (Table 4). Moderate to good test-retest reliability was found between questionnaire takers. Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. The CSSRS has been validated in multiple settings (including the ED and inpatient setting in patients with mental health problems). Adolescents reported interest in receiving education about sexual health topics, such as STIs, contraception, and HIV, in the ED. The AAP designates this enduring material for a maximum of 40.00 AMA PRA Category 1 Credit (s). A concussion is a type of traumatic brain injury (TBI) that temporarily disrupts normal brain function. The Social Needs Screening tool screens for five core health-related social needs, which include housing, food, transportation, utilities, and personal safety, using validated screening questions,. In the full-text screen, both reviewers included 43 studies and excluded 25 studies; 7 studies were in conflict. Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). Your Preemie's Growth & Developmental Milestones 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. 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. E-mail: Search for other works by this author on: Achieving quality health services for adolescents, Centers for Disease Control and Prevention, Opportunistic adolescent health assessment in the child protection unit, Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? Screening and Counseling Adolescents and Young Adults: A - AAFP To access log in and visit We calculated Cohens to assess interrater reliability. Assessment of Respiratory Function in Infants and Young Children - JAMA Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. 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. Comprehensive Adolescent Risk Behavior Screening Studies. 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. 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. Almost all adolescents agreed that nurses should screen for suicide risk in the ED. Geopolitical boundaries do not circumscribe health issues and nowhere is this more obvious than in Los Angeles. 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?. 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. Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? With the heterogeneity of studies included, we could only summarize findings but could not perform a meta-analysis. 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. endstream endobj 322 0 obj <>stream HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. 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 (. 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. This study was determined exempt by the Institutional Review Board at the University of California, San Francisco. 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). When patients screen positive for risky behaviors, it is imperative to have strategies and resources in place to address these behaviors. 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 support suicide risk screening in the ED. Next, the 2 reviewers independently completed a full-text screen. 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. 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. These findings were more pronounced in adolescents without symptoms of STI (28.6% vs 8.2%; OR 4.7 [95% CI 1.415.5]).28 In a study by Miller et al29 done in the ED setting, MI was found to be a feasible, timely, and effective technique in promoting sexual health in adolescents. Prevalence of IPV was 36.6% in screened patients. 2010;38(10):746-761; American Academy of Pediatrics Section on Pediatric Dentistry and Oral Health. Further study of technology-based behavioral interventions is warranted. Six-five percent agreed to screening (. Forty-six percent of patients were due for the human papillomavirus (HPV) vaccine, and 19% of these received it during admission.25. Sexual history documentation was incomplete in charts of adolescents discharged from the ED with STI diagnosis. 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. Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. A majority of patients in the ED did not prefer EPT, and clinicians should address concerns if they do plan to prescribe EPT. 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. Current Concepts in Concussion: Initial Evaluation and Management For more educational content visitwww.pedialink.org. Your child's doctor will want to know when and how the injury happened and how your child is feeling. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). 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. Falcn et al61 found that, during implementation of a standardized screening program, it was important to minimize workflow disruption and provide adequate education to achieve participant buy-in. Below we report results by risk behavior domain, with studies organized into subcategories of screening rates, screening tools and interventions, and adolescent, parent, and clinician attitudes toward screening and intervention. A significant percentage of sexually active adolescents surveyed were potential candidates for EC. Already purchased? After duplicates were removed, 1867 unique studies were identified. PDF Pain Management in Infants, Children, Adolescents, and - AAPD Of those who ended up needing it, 92% had answered yes before knowing. The DISC Cannabis Symptoms was reported to have a sensitivity of 96%, a specificity of 86%, and an LR+ of 6.83. Tools to aid. 2003; 122(6):1387-1394; and American Academy of Pediatrics Section of Pediatric Dentistry. 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). The Newton Screen had better sensitivity for cannabis use and good specificity for both. 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 shorter versions of AUDIT (AUDIT-C and AUDIT-PC) failed to identify a significant proportion of adolescents with a positive AUDIT-10 result. Concussions: What Parents Need to Know - HealthyChildren.org 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). HEADSS: The "Review of Systems" for Adolescents 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. Adolescent Risk Behavior Screening and Interventions in the Hospital Setting. Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. Buy-in from physicians was difficult in the implementation phase. Most adolescents have few physical health problems, so their medical issues come from risky behaviors. An MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. 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. 321 0 obj <>stream 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. 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%). This fast movement can cause the brain to bounce around or twist in the skull, creating . ASQ on a validated self-screening tablet tool. 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. Health risk behaviors in adolescents with chronic conditions, Health risk screening in adolescents: room for improvement in a tertiary inpatient setting, Hospital readmission of adolescents and young adults with complex chronic disease, Systematic review or scoping review? 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). In this study, the terms hospitalized or hospital setting refer to patients admitted to pediatric units under either inpatient or observation status. We report on evaluation of the network after 10 years of operation by reviewing program context, input, processes, and products to measure its progress in performing educational research that advances . The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 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. 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. Adolescents preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors? Survey of hospitalists to assess beliefs and practices surrounding sexual and reproductive health screening and interventions. In the Supplemental Information, we outline the details of our search strategy. Copyright 2023 American Academy of Pediatrics. 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. A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. Newton Screen: 3 questions on substance use based on DSM5 aimed at adolescents (self-administered tablet tool with follow-up phone calls), Alcohol use disorder: sensitivity = 78.3%, specificity = 93%; cannabis use disorder: sensitivity = 93.1%, specificity = 93.5%. The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! 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). Eighty-two percent of patients who screened positively were referred to outpatient mental health, and 10% were admitted to a psychiatric facility. HEADS UP to Health Care Providers: Tools for Providers 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. 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). 28 Apr 2023 20:21:28 Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). Prevalence of suicidality in asymptomatic adolescents in the paediatric emergency department and utility of a screening tool, Suicide evaluation in the pediatric emergency setting, Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department, Universal adolescent suicide screening in a pediatric urgent care center, Adolescent and parent attitudes toward screening for suicide risk and mental health problems in the pediatric emergency department, Patients opinions about suicide screening in a pediatric emergency department, Asking youth questions about suicide risk in the pediatric emergency department: results from a qualitative analysis of patient opinions, Adolescent depression: views of health care providers in a pediatric emergency department, Instruments to detect alcohol and other drug misuse in the emergency department: a systematic review, Pediatric Emergency Care Applied Research Network, Reliability and validity of the Newton Screen for alcohol and cannabis misuse in a pediatric emergency department sample, Utility of the AUDIT for screening adolescents for problematic alcohol use in the emergency department, Reliability and validity of a two-question Alcohol screen in the pediatric emergency department, Adolescent substance use: brief interventions by emergency care providers, Screening, brief intervention, and referral to treatment for adolescent alcohol use in Canadian pediatric emergency departments: a national survey of pediatric emergency physicians, Perceived barriers to implementing screening and brief intervention for alcohol consumption by adolescents in hospital emergency department in Spain, Risk factors for dating violence among adolescent females presenting to the pediatric emergency department, Adolescent relationship abuse: how to identify and assist at-risk youth in the emergency department, American Academy of Pediatrics. 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. A significant proportion of adolescents were interested in starting contraception in the ED. ED physicians used SBIRT in limited and nonstandardized ways. Two of the studies took place in the hospital setting and 4 in the ED setting. h222W0Pw/+Q0,H/-K-0 = Screening Tools: Pediatric Mental Health Minute Series - AAP 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 ASQ is a brief tool to assess suicide risk in pediatric patients in the ED and has a high sensitivity, specificity, and NPV. 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. 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). Pediatrics. 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. This IMPACT project analyzes which factors are associated with HEADSS assessment completion and aims . hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd 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]). After a title and abstract screen, 75 studies remained. hZkoG+!!E@@ (a02Zga%soUOO{R"'z{[M Ol5 8~pls48_ Oral health risk assessment timing and establishment of the dental home. 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. 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. The studies in our review reveal ubiquitously low rates of risk behavior screening in the ED and hospital setting across all risk behavior domains. All students are required to complete an observed HEADSS assessment over the course of their clerkship. With the COVID-19 pandemic, this activity . RCT, randomized controlled trial; , not present; +, present. Our findings can help guide efforts in these settings to advance screening and interventions for risk behaviors, thereby improving health outcomes for adolescents. l+PxF.wYh|:7#jvUF\A_Xr9Gs#C:Ynu,-,-AFk[,b5+"*,gbJW*;A[PA[r}Xq~jy!.N(7kF f 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. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. The FRAMES acronym tool can be used to outline brief interventions. 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%). SI screening of all patients in the ED is feasible and acceptable to adolescent patients. 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.
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