Abstract. 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. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. 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. Semistructured interviews of clinicians to assess perceptions of depression in the adolescent population and thoughts about screening for depression in the ED. 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. Adolescents prefer in-person counseling and target education (related to their chief complaint). Fein et al49 found that with the BHS-ED, mental health problem identification increased from 2.5% to 4.2% (OR 1.70; 95% CI 1.382.10), with higher rates of social work or psychiatry evaluation in the ED (2.5% vs 1.7%; OR 1.47 [95% CI 1.131.90]). 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. 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. The AAP has developed and published position statements with recommended public policy and clinical approaches to reduce the incidence of firearm injuries in children and adolescents and to reduce the effects of gun violence. Further research is needed to assess the effectiveness of the CDS system in improving adolescent sexual health care. The goal of the training is to provide an overview of the evidence-based recommendations outlined in the CDC Pediatric mTBI Guideline and to equip healthcare . More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. *0zx4-BZ8Nv4K,M(WqhQD:4P H!=sb&ua),/(4fn7L
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|(|w .AFX 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. Fewer than half of respondents used a validated tool when screening for alcohol use. Headache is the most common symptom. Pediatrics April 2021; 147 (4): e2020020610. We acknowledge Evans Whitaker, MD, MLIS, for his assistance with the literature search. Interview, primary question of interest: Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. Two independent reviewers screened, extracted, and summarized the studies (N.P. 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. More recently, researchers evaluated a self-administered 3-item screening tool based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the Newton Screen, concluding that it was a brief and effective tool for screening both alcohol (sensitivity of 78.3% and specificity of 93%) and cannabis use (sensitivity of 93.1% and specificity of 93.5%).56, In a study on the use of the Alcohol Use Disorder Identification Test (AUDIT) tool, researchers observed differences in sensitivity based on the age group of adolescents, noting lower utility in younger adolescents.57 The National Institute of Alcohol Abuse and Alcoholism 2-question screen, a self-administered tool via tablet that features 2 different questions for middle schoolaged versus high schoolaged adolescents, was found to be a valid and brief way to screen for alcohol use in the ED.58, For positive screen results, MI and brief intervention tools, such as the FRAMES acronym (feedback, responsibility, advice, menu, empathy, self-efficacy) have been found to be effective in addressing high-risk behaviors, particularly in adolescent patients. 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. 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. HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. 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. A 2-question SI screen was piloted by Patel et al50 in an urgent care setting to identify adolescents at risk for SI. 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. screening1,2 responsible adult is a modified HEADSSscreening, which has toask the rightbeentaught in adolescent medicine and pediatric training questions. Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. To overcome these collective barriers, future researchers should investigate (1) feasible, efficient risk behavior screening tools with guidance for clinicians on providing risk behavior interventions and (2) tools that increase privacy and comfort for patients (likely through the use of electronic formats). Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. 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. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. Of respondents, 76.5% preferred an electronic survey to face-to-face interviews. To access log in and visit The HEADSS stamp resulted in a significant increase in postintervention screening rates (from <1% to 9%; P = .003).21 The EHR distress response survey by Nager et al22 was found to be feasible to integrate into the busy ED physician workflow, but the study offered limited insight into effects on screening or utility of the tool (assessed by using only yes or no questions). 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. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of . 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 Preventive oral health intervention for pediatricians. In the full-text screen, both reviewers included 43 studies and excluded 25 studies; 7 studies were in conflict. The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. Many adolescents felt the ED should universally provide education on sexual and reproductive health practices and provide contraceptive services, especially for patients who may not have access to a primary provider.25,3032 Chernick et al33 found that one-fourth of the adolescent patients in their study were interested in receiving contraception in the ED. 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 biggest concerns from adolescent patients included worries about privacy issues.51, Parental reservations regarding screening were focused on the patient being in too much pain or distress for screening.46 Other identified hesitations were fear of a lack of focus on nonpsychiatric chief complaints and possible iatrogenic harm secondary to screening.53, Clinicians felt that a computerized depression screen would overcome many of the identified barriers (lack of rapport, time constraints, high patient acuity, lack of training or comfort, privacy concerns, and uncertainty with next steps), but they endorsed a need for support to facilitate connecting patients with mental health resources and interventions.54. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? In the intervention arm, the results of the screen provided decision support for ED physicians. 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. 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. 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). Comprehensive Adolescent Risk Behavior Screening Studies. 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. Further study is warranted. A majority of patients in the ED did not prefer EPT, and clinicians should address concerns if they do plan to prescribe EPT. 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. We excluded studies that involved outpatient follow-up of patients to evaluate interventions that could be completed in the ED or hospital setting, but this may have limited our review of more longitudinal effects. Almost all patients deemed to have elevated suicide risk endorsed SI (SIQ-JR) and/or had a recent suicide attempt. 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. 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. The developmental milestones are listed by month or year first because well-child visits are organized this way. 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. RT @nancydoylebrown: David Leonhardt continues: "The effects were worst on low-income, Black and Latino children. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). HEADS UP to Healthcare Providers is a free online training developed by CDC and the American Academy of Pediatrics. 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. A model of 4 candidate questions (ASQ) was found to have a sensitivity of 96.9%, a specificity of 87.6%, and an NPV of 99.7%. There were no studies on patient or parent attitudes toward substance use screening or interventions. 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. However, none of the patients screened positive for SI on the SIQ (comparison standard). Two of the studies took place in the hospital setting and 4 in the ED setting. There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. The Academic Pediatric Association (APA) and the American Academy of Pediatrics (AAP) recently authorized task forces to address child poverty.8As a work-group of the APA Childhood Poverty Task Force Health Care Delivery Committee, we provide an evidence-based, practical approach to those aspects of surveillance and screening that apply 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%. Reported barriers were time constraints and limited resources. MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. 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). The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! The ED visit may provide an opportunity to meet the contraceptive needs of adolescents, particularly for those who do not receive regular well care. Overall risk of bias was as follows: low, 1 variable not present; moderate, 23 variables not present; and high, 45 variables not present.
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