One study that met inclusion criteria was found post hoc and included in the final review for a total of 46 studies (Fig 1). 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. Adolescents expressed that screening could lead to identification, prevention, and treatment of suicidal thoughts and/or behavior as well as provide an opportunity to connect with the nurse for those who lack other sources of support. Download ACE Care Plan - Work version ACE Care Plan - School version Documentation of sexual activity screening of adolescents was low in both ED and hospital settings. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). 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. If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. No charts contained documentation on other important risk-stratifying details, such as contraception use other than condoms, the sex of partners, partners risk of STIs, anal sex practice, or partners drug use.27 None of these studies reported on whether privacy was ensured in sexual history taking, although they did mention the need for confidentiality as a possible barrier to higher rates of screening.2326, McFadden et al25 described sexual health services provided in the hospital setting and reported that STI testing was conducted in 12% of patients, that pregnancy testing was done in 60% of female patients, and that contraception was provided for 2% of patients. The experiences and opportunities offered in early childhood lay the foundation for how children grow, learn, build relationships, and prepare for school. The RSQ, a verbal 4-question suicide screening instrument, Twenty-two percent of patients screened positive on the RSQ. Behavioral Health ScreeningEmergency Department, Diagnostic Interview Schedule for Children, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, feedback, responsibility, advice, menu, empathy, self-efficacy, home, education, activities, drugs, sexual activity, suicide and/or mood, screening, brief intervention, and referral to treatment. 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). Tools to aid. Welcome to HEADS-ED. Another option is creating labeling functions within the EHR for children aged 13 to 18 so clinicians can label whether each problem, medication, or diagnostic test result can be accessed by the patient, parents, or both.69 In a recently published scoping review, Wong et al70 further explore possible systemic solutions in designing digital health technology that captures and delivers preventive services to adolescents while maximizing safety and privacy. Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. We acknowledge Evans Whitaker, MD, MLIS, for his assistance with the literature search. Your child's doctor will want to know when and how the injury happened and how your child is feeling. Cohens was calculated and determined to be 0.8, correlating with a 90.7% agreement. The assessment starts with simple and easy questions about life to allow a . 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. 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. In 75% of cases in which risk behaviors were identified, interventions were provided. CRAFFT is a valid substance use screening tool for the adolescent population. 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. The Sexual Health Screen reported on by Goyal et al35 presents a feasible and valid way to screen for sexual and reproductive health. A significant percentage of sexually active adolescents surveyed were potential candidates for EC. The American Academy of Pediatrics (AAP) and other organizations recommend using this assessment in order to address risk behaviors. 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. PDF Getting into adolescent heads: An essential update - University of Arizona 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 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. HEADSSS Assessment - TeachMePaediatrics - Home - Education Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. 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. Already purchased? The CSSRS has been validated in multiple settings (including the ED and inpatient setting in patients with mental health problems). Mental health is an essential component of overall health. MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up 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. Survey to assess sexual history, sexual health knowledge, and desire for sexual health education. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of . 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. screening1,2 responsible adult is a modified HEADSSscreening, which has toask the rightbeentaught in adolescent medicine and pediatric training questions. Two of the studies took place in the hospital setting and 4 in the ED setting. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. Web-based questionnaire on pregnancy risk. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. Of those who ended up needing it, 92% had answered yes before knowing. We pooled results from both queries together and removed duplicates. The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. 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. 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?. . The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. Current Concepts in Concussion: Initial Evaluation and Management 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. 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. ADHD - Caring for Children With ADHD: A Practical Resource Toolkit for Oral health risk assessment timing and establishment of the dental home. Female adolescents showed preference for in-person counseling, from a person of authority (doctor, nurse) rather than from a peer counselor. 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. ED clinicians acknowledged the importance of depression screening. All rights reserved. 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. HEADS UP to Health Care Providers: Tools for Providers Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established. 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 (. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. 2003; 122(6):1387-1394; and American Academy of Pediatrics Section of Pediatric Dentistry. We conducted a literature search in June 2019. 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 All children should wear masks in school this fall, even if vaccinated There is a high unintended pregnancy risk in adolescents using the ED. The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . The developmental milestones are listed by month or year first because well-child visits are organized this way. Adolescents expressed that screening could lead to identification, prevention, and treatment of suicidal behavior. Clinicians were comparatively less accepting, particularly if the visit was not related to sexual health. Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. and A.D.). 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. 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. In the intervention arm, the results of the screen provided decision support for ED physicians. Depression increased, and the American Academy of Pediatrics declared a national emergency in children's mental health." (And to think we called you racist for pleading for open schools.) 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). Study design and risk of bias are presented in Table 1. Questionnaire used to assess beliefs regarding screening and intervention for suicide risk and other mental health problems in the ED. Two-thirds of patients surveyed did not prefer EPT and cited reasons such as importance of determining partner STI status, partner safety, partner accountability, and importance of clinical interaction. 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). More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. RCT, randomized controlled trial; , not present; +, present. For COVID related questions, please emailcovid-19@aap.org.For Mental Health related questions, please emailmentalhealth@aap.org.Brought to you by AAP Education. l+PxF.wYh|:7#jvUF\A_Xr9Gs#C:Ynu,-,-AFk[,b5+"*,gbJW*;A[PA[r}Xq~jy!.N(7kF f PDF Pain Management in Infants, Children, Adolescents, and - AAPD A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines flowchart of study selection. How Pediatricians Screen for Autism - HealthyChildren.org With the heterogeneity of studies included, we could only summarize findings but could not perform a meta-analysis. 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. Revisions: 7. Parents were overall supportive of sexual activity screening and care provision in the ED and hospital setting. An MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. 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). Pediatrics. Fewer than half of respondents used a validated tool when screening for alcohol use. 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. 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. HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. 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. There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd Concussions: What Parents Need to Know - HealthyChildren.org Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. Six-five percent agreed to screening (. 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. 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.
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