headss assessment american academy of pediatrics

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. ED and Urgent Care Adolescent Risk Behavior Screening and Interventions. 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. 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. A significant proportion of adolescents who screened positive for elevated suicide risk in the ED were presenting for nonpsychiatric reasons. CRAFFT is a valid substance use screening tool for the adolescent population. However, many barriers to screening in the ED setting were reported. ED clinicians acknowledged the importance of depression screening. 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. 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%). Only 1.2% used SBIRT consistently. A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? The NIAAA 2-question screen is a valid and brief way to screen for alcohol use in pediatric EDs. 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. Guidance for authors when choosing between a systematic or scoping review approach, PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation, Rayyan-a web and mobile app for systematic reviews, Families experiences with pediatric family-centered rounds: a systematic review, Opportunistic adolescent health screening of surgical inpatients, Reaching adolescents for prevention: the role of pediatric emergency department health promotion advocates, Raising our HEADSS: adolescent psychosocial documentation in the emergency department, Mental health screening among adolescents and young adults in the emergency department. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. 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. A sexual health CDS system for adolescents in the ED received high acceptability and usability ratings from ED clinicians and adolescents. After duplicates were removed, 1867 unique studies were identified. 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. Your child's doctor will want to know when and how the injury happened and how your child is feeling. Study design and risk of bias are presented in Table 1. 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. Most clinicians agreed that computerized depression screening could be a suitable approach to address many of the identified barriers to screening. Of respondents, 76.5% preferred an electronic survey to face-to-face interviews. hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd Oral health risk assessment timing and establishment of the dental home. Given that guidelines recommend universal risk screening of all adolescents, we excluded studies that were focused only on high-risk adolescents, such as patients admitted to adolescent medicine, trauma, or psychiatry services or patients admitted for toxic ingestions, suicide, or eating disorders. 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. 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). We calculated Cohens to assess interrater reliability. A patient was more likely to have documentation if the note was written by an intern (, Sexual and menstrual history documentation. Clinicians were comparatively less accepting, particularly if the visit was not related to sexual health. HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. To access log in and visit The ACE (Acute Concussion Evaluation) forms are patient assessment tools. Approximately 4% of younger adolescents (aged 1315; The AUDIT-10 may be a less useful tool in the younger adolescent population (1315) compared with the older adolescent population (1617) given the low rate of positive screen results in the younger group. We also excluded any studies with interventions taking place outside the urgent care, ED, or hospital because we aimed to identify interventions that could be completed during acute care encounters. Feasibility of screening patients with nonpsychiatric complaints for suicide risk in a pediatric emergency department: a good time to talk? 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. Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. Pain assessment is an integral component of the dental history and comprehensive evaluation. Screening in the urgent care setting helped identify adolescents at risk for SI, most of whom did not have mental healthrelated chief complaints, and this led to interventions in the form of referrals or urgent admission. 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). 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. Adolescents prefer in-person counseling and target education (related to their chief complaint). Adolescents in the intervention group were more likely to receive STI testing compared with those in the control arm (52.3% vs 42%; odds ratio [OR] 2.0 [95% confidence interval (CI) 1.13.8]). Self-administered tablet questionnaire: NIAAA 2-question screen (the 2 questions differed between high schoolaged and middle schoolaged adolescents). Almost all patients deemed to have elevated suicide risk endorsed SI (SIQ-JR) and/or had a recent suicide attempt. Studies were included on the basis of population (adolescents aged 1025 years), topic (risk behavior screening or intervention), and setting (urgent care, ED, or hospital). 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. High risk for SI was identified in 93.4% of yes respondents and in 84.5% of the no response group. 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. 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. 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. Teen preferences for clinic-based behavior screens: who, where, when, and how? We found that although clinicians and patients are receptive to risk behavior screening and interventions in these settings, they also report several barriers.54 Clinicians are concerned that parents may object to screening; however, parents favor screening and intervention as long as their child is not in too much pain or distress.46 Clinicians additionally identify obstacles such as time constraints, lack of education or knowledge on the topic, and concerns about adolescent patients reactions.40,60,61 Additionally, adolescent patients report concerns around privacy and confidentiality of disclosed information.51. RCT, randomized controlled trial; , not present; +, present. 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?. 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. We only included studies published in English. 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. Reported barriers were time constraints and limited resources. 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. 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. We're 67,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. 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. Patient-administered 22- to 27-item survey on attitudes toward inpatient reproductive health screening and interventions. 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 Specifically, 5 of 10 patients who met criteria for inpatient psychiatric facility admission did not have an initial mental healthrelated chief complaint.50, In a cross-sectional survey, OMara et al51 found that after a positive screen result, the majority of adolescent patients and their parents valued the chance for immediate intervention and resources in the ED. Almost all adolescents agreed that nurses should screen for suicide risk in the ED. Three ED studies described interventions to increase comprehensive risk behavior 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. The Newton Screen may be a good brief screening tool for assessing alcohol and cannabis use. 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 . .Z\S(?CvRx(6?X8TTnY-k!/.~zNV?-.,/O]b1:z>=Z. 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. Welcome to HEADS-ED. 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]). Female adolescents and parents were generally more supportive of mental health screening (other than suicide risk) than their male counterparts. and A.D.). Previous studies indicate low rates of risk behavior screening and interventions in ED and hospital settings. 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]). Data sources included PubMed (19652019) and Embase (19472019). SI screening of all patients in the ED is feasible and acceptable to adolescent patients. In the intervention arm, the results of the screen provided decision support for ED physicians. Headache is the most common symptom. 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. 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. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. Further study of technology-based behavioral interventions is warranted. Survey to assess sexual history, sexual health knowledge, and desire for sexual health education. 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. 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. 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. For more educational content visitwww.pedialink.org. The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. Further research is needed to assess the effectiveness of the CDS system in improving adolescent sexual health care. Adolescents reported high rates of risky behaviors and interest in receiving interventions for these behaviors. 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. In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (10%) but significant increases with clinician reminder implementation. A significant percentage of sexually active adolescents surveyed were potential candidates for EC. ED-DRS, Emergency Department Distress Response Screener. Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. We acknowledge Evans Whitaker, MD, MLIS, for his assistance with the literature search. ASQ on a validated self-screening tablet tool. Computerized health survey and guided decision-making tool for physicians in intervention arm. If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. The RSQ, a verbal 4-question suicide screening instrument, Twenty-two percent of patients screened positive on the RSQ. If your child is alert and responds to you, the head injury is mild and usually no tests or X-rays are needed. In 75% of cases in which risk behaviors were identified, interventions were provided. We report on a number of successful domain-specific screening tools validated in ED and hospital settings. Pediatrics. 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. The majority of ED physicians felt that the ED was an appropriate venue for screening and intervention on alcohol use disorders. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . Our data sources included PubMed (19652019) and Embase (19472019). Next, the 2 reviewers independently completed a full-text screen. Web-based questionnaire on pregnancy risk. Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus limiting generalizability. 28 Apr 2023 20:21:28 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). Copyright American Academy of Pediatrics. . Adolescents have suboptimal rates of preventive visits, so emergency department (ED) and hospital visits represent an important avenue for achieving recommended comprehensive risk behavior screening annually. Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent? Our findings can help guide efforts in these settings to advance screening and interventions for risk behaviors, thereby improving health outcomes for adolescents. The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI. Most adolescents and parents rated screening for suicide risk and other mental health problems in the ED as important. Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. Teenagers report wanting to receive pregnancy and STI preventive care in the ED, regardless of the reason to visit. For intimate partner violence and adolescent relationship abuse, Jackson et al63 outline successful outpatient interventions (eg, universal wallet-sized educational cards and targeted computerized interventions) that could be feasible in the ED setting but would require further investigation. 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%. 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. 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. Overall risk of bias was as follows: low, 1 variable not present; moderate, 23 variables not present; and high, 45 variables not present. For anything more than a light bump on the head, you should call your child's doctor. 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. programs for many years.3The rationale behind the modification includes It begins with strengths. Adolescents reported interest in receiving education about sexual health topics, such as STIs, contraception, and HIV, in the ED. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of . Comprehensive Adolescent Risk Behavior Screening Studies. The Sexual Health Screen reported on by Goyal et al35 presents a feasible and valid way to screen for sexual and reproductive health. Adolescents preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors? The assessment starts with simple and easy questions about life to allow a . In a narrative review by Jackson et al63 on adolescent relationship abuse screening and interventions in the ED, the authors described successful outpatient interventions that could be easily adapted for the ED setting. 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. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Seven studies on substance use screening and intervention were included in our review; all took place in the ED setting (Table 4). One study that met inclusion criteria was found post hoc and included in the final review for a total of 46 studies (Fig 1). 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. Copyright 2023 American Academy of Pediatrics. 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 ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. Less than half of admitted patients had documented menstrual (32.8%) or sexual history (45.9%). After a title and abstract screen, 75 studies remained. Only 62% of charts had sexual history documented in the admission H&P, and among those patients who did have documentation, 50.5% were found to be sexually active. 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. Adolescent Risk Behavior Screening and Interventions in the Hospital Setting. 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 authors concluded that a more general psychosocial risk screen, such as the HEADSS, should be implemented instead.47 Ambrose and Prager48 described potential screening tools for SI (eg, ASQ and RSQ) and concluded that these tools need further prospective study and validation in a general population of adolescents without mental health complaints. However, lack of initial physician buy-in and administrative hurdles, such as funding for HPAs, training, and competition with other medical professionals (ie, social workers), made it difficult to transition this intervention into sustainable clinical practice.20 In 2 studies, researchers evaluated physician reminders to screen, including a home, education, activities, drugs, sexual activity, suicide and/or mood (HEADSS) stamp on paper medical charts and a distress response survey in the electronic health record (EHR). Sexual activity self-disclosure tool (ACASI). Data extracted from the full texts included the full citation, study type, risk of bias, risk behavior domain, intervention or screening tool, results of the study, and conclusions. endstream endobj 322 0 obj <>stream However, none of the patients screened positive for SI on the SIQ (comparison standard). The Vanderbilt rating scale assesses symptoms of attention deficit disorder as well as oppositional and anxious behaviors. Most adolescents support suicide risk screening in the ED. Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. 2003; 122(6):1387-1394; and American Academy of Pediatrics Section of Pediatric Dentistry. Investigates different SI screening tools used in ED. Female adolescents showed preference for in-person counseling, from a person of authority (doctor, nurse) rather than from a peer counselor. MI and brief intervention are effective methods to address high-risk behaviors. hZkoG+!!E@@ (a02Zga%soUOO{R"'z{[M Ol5 8~pls48_ Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. The DISC Cannabis Symptoms was reported to have a sensitivity of 96%, a specificity of 86%, and an LR+ of 6.83. A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. Details on risk level were frequently left out. Survey of 17 candidate suicide screening questions. Survey of hospitalists to assess beliefs and practices surrounding sexual and reproductive health screening and interventions. The ED visit may provide an opportunity to meet the contraceptive needs of adolescents, particularly for those who do not receive regular well care. Six-five percent agreed to screening (.

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