A significant proportion of adolescents were interested in starting contraception in the ED. Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. The CSSRS has been validated in multiple settings (including the ED and inpatient setting in patients with mental health problems). 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 . Survey eliciting sexual history, preferences for partner STI notification, and partner EPT. Survey of 17 candidate suicide screening questions. 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 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. More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. 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. As physicians, we need to ask about the context of a teen's life, and the HEADSS assessment is a good guide. We conducted a literature search in June 2019. Promising solutions include self-disclosure via electronic screening tools, educational sessions for clinicians, and clinician reminders to complete screening. Computerized survey to assess sexual history and interest in interventions in the ED. Three ED studies described interventions to increase comprehensive risk behavior screening. 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]). 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. 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. Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. 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. l+PxF.wYh|:7#jvUF\A_Xr9Gs#C:Ynu,-,-AFk[,b5+"*,gbJW*;A[PA[r}Xq~jy!.N(7kF f 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). Six-five percent agreed to screening (. In the Supplemental Information, we outline the details of our search strategy. 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 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. 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,. Comprehensive Adolescent Risk Behavior Screening Studies. A 2-question SI screen was piloted by Patel et al50 in an urgent care setting to identify adolescents at risk for SI. After duplicates were removed, 1867 unique studies were identified. programs for many years.3The rationale behind the modification includes It begins with strengths. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth, Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review, The role of motivational interviewing in children and adolescents in pediatric care. Dr Pfaff conceptualized and designed the study, conducted the literature search, screened literature for inclusion, extracted data from included studies, and drafted and edited the manuscript; Dr DaSilva helped in study design, conducted the literature search, screened literature for inclusion, extracted data, and helped with drafting the original manuscript; Dr Ozer helped in study design, editing and revising the manuscript, and critically appraising the manuscript content; Dr Kaiser supervised the conceptualization and design of the study, supervised the data extraction from the included literature, and helped in revising and editing the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. 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. Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. 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. HEADS-ED - Welcome to HEADS-ED 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. 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. Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in 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. Immediate intervention in the ED and receiving information for follow-up care were rated as the most helpful responses to a positive screening result. Prevalence of IPV was 36.6% in screened patients. Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). Welcome to HEADS-ED. Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus limiting generalizability. Forty-six studies were included; most (38 of 46) took place in the ED, and a single risk behavior domain was examined (sexual health [19 of 46], mood and suicidal ideation [12 of 46], substance use [7 of 46], and violence [2 of 46]). In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. 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. Only 1.2% used SBIRT consistently. The ED visit may provide an opportunity to meet the contraceptive needs of adolescents, particularly for those who do not receive regular well care. ED and Urgent Care Adolescent Risk Behavior Screening and Interventions. Preventive care for adolescents: few get visits and fewer get services, Patterns of primary care physician visits for US adolescents in 2014: implications for vaccination, Adolescent health, confidentiality in healthcare, and communication with parents, Adolescents who use the emergency department as their usual source of care. We only included studies published in English. 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). Adolescents preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors? An MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. HEADS-ED is an easy-to-use screening tool that physicians, nurses, intake workers, and other mental health caregivers can use during a patient visit to identify mental health and addictions needs from early infancy to transitional aged youth. Early childhood is a pivotal period of child development that begins before birth through age 8. The American Academy of Pediatrics on Monday recommended that all children over the age of 2 wear masks when returning to school this year, regardless of vaccination status. . ACA, adaptive conjoint analysis; ACASI, audio-enhanced computer-assisted self-interview; ARA, adolescent relationship abuse; AUDIT-C, Alcohol Use Disorders Identification TestConsumption; AUDIT-PC, Alcohol Use Disorders Identification Test-(Piccinelli) Consumption; AUDIT-3, 3-Item Alcohol Use Disorder Identification Test; AUDIT-10, 10-Item Alcohol Use Disorder Identification Test; BHS, Beck Hopelessness Scale; BIS-11, Barratt Impulsivity Scale; CAGE, Cut down, Annoyed, Guilty, Eye-opener; CDS, clinical decision support; CRAFFT, Car, Relax, Alone, Forget, Friends, Trouble; CSSRS, Columbia Suicide Severity Rating Scale; CT, Chlamydia trachomatis; CTS, Conflict Tactics Survey; DSM5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; EC, emergency contraception; ED-DRS, Emergency Department Distress Response Screener; EPT, expedited partner therapy; ER, emergency department; FAST, Fast Alcohol Screening Test; GC, Neisseria gonorrhoeae; HCP, health care provider; HEADS-ED, Home, Education, Activities and peers, Drugs and alcohol, Suicidality, Emotions and behaviors, Discharge resources; IPV, intimate partner violence; LARC, long-acting reversible contraception; LR+, positive likelihood ratio; NIAAA, National Institute of Alcohol Abuse and Alcoholism; NP, nurse practitioner; NPV, negative predictive value; POSIT, Problem Oriented Screening Instrument for Teenagers; PRI, pregnancy risk index; PTSD, posttraumatic stress disorder; RADS-2, Reynolds Adolescent Depression Screening, Second Edition; RAFFT, Relax, Alone, Friends, Family, Trouble; RAPS4-QF, Remorse, Amnesia/blackouts, Perform, Starter/eye-opener, Quantity, Frequency; RBQ, Reckless Behavior Questionnaire; RUFT-Cut, Riding with a drinking driver, Unable to stop, Family/Friends, Trouble, Cut down; SIQ, Suicidal Ideation Questionnaire; SIQ-JR, Suicidal Ideation Questionnaire Junior; STD, sexually transmitted disease; TWEAK, Tolerance, Worried, Eye-opener, Amnesia, Kut-down . The FRAMES acronym tool can be used to outline brief interventions. HEADSSS Assessment - TeachMePaediatrics - Home - Education It appears you are using Internet Explorer as your web browser. 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 Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. Adolescents reported high rates of risky behaviors and interest in receiving interventions for these behaviors. 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. This demonstrates that we do not viewyouth only in the risk context. 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%. 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]). HEADSS: The "Review of Systems" for Adolescents Similarly, in 2 qualitative studies by Ballard et al,52,53 90% to 96% of interviewed adolescents responded positively to SI screening in the ED. 13-20% of children in the U.S. experience a mental health disorder each year. MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. Buy-in from physicians was difficult in the implementation phase. In an ED survey study by Ranney et al,23 for all risk behavior categories assessed, 73% to 94% of adolescent patients (n = 234) were interested in interventions, even when screen results were negative. The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. Adolescent Risk Behavior Screening and Interventions in Hospital 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). We developed the rapid screening tool home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED), which is a modification of "HEADS," a mnemonic widely used to obtain a psychosocial . The HEADSS Assessment: A Virtual Psychosocial Interview for - AAMC 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. ADHD - Caring for Children With ADHD: A Practical Resource Toolkit for 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. IMPACT Program | Children's Hospital Los Angeles 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.
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