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. Within each category, we grouped studies by subcategory: screening rates, screening and intervention tools, and attitudes toward screening and intervention. The Sexual Health Screen reported on by Goyal et al35 presents a feasible and valid way to screen for sexual and reproductive health. If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. However, many barriers to screening in the ED setting were reported. Overall risk of bias was as follows: low, 1 variable not present; moderate, 23 variables not present; and high, 45 variables not present. Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. 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. 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. A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). A significant proportion of adolescents who screened positive for elevated suicide risk in the ED were presenting for nonpsychiatric reasons. More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. Three ED studies described interventions to increase comprehensive risk behavior screening. When implementing an alcohol use screening and/or intervention program for adolescents in the ED, it is important to minimize workflow disruption caused by the program and provide adequate education to achieve staff participation. 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. Further study of technology-based behavioral interventions is warranted. 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). More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. Risky behaviors present a great threat to adolescent health and safety and are associated with morbidity into adulthood.1,2 Unintended pregnancy, sexually transmitted infections (STIs), substance use, suicide, and injury are the primary causes of morbidity and mortality in those aged 10 to 24 years.3 Risky behaviors are prevalent among US high school students, with 35% reporting alcohol use, 23% reporting marijuana use, and 47% reporting sexual activity (but only 59% reporting using a condom during their last sexual encounter).1 Consequently, the American Academy of Pediatrics recommends comprehensive risk behavior screening at annual preventive care visits during adolescence,4 with the goal of identifying risk behaviors and providing risk behaviorrelated interventions (eg, STI testing).5. For anything more than a light bump on the head, you should call your child's doctor. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. Revisions: 7. 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. 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%). There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. 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. Also, most studies had limited durations of follow-up, so we cannot comment on long-term effects. 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. 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). 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. 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. Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward 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. The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. Fewer than half of respondents used a validated tool when screening for alcohol use. The CSSRS has been validated in multiple settings (including the ED and inpatient setting in patients with mental health problems). The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI. Welcome to HEADS-ED. 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. In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. 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. Sexual activity (patient and clinician attitudes), Computerized survey to assess acceptability and usefulness of a sexual health CDS system. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Four screening questions identified 99% of patients who had experienced IPV. endstream endobj 323 0 obj <>stream 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%. 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. 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. Teen preferences for clinic-based behavior screens: who, where, when, and how? CRAFFT is a valid substance use screening tool for the adolescent population. 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. 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. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. You can find the latest versions of these browsers at https://browsehappy.com. Sexual activity self-disclosure tool (ACASI). It is important to conduct adolescent substance use screening in the ED. 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. We conducted a literature search in June 2019. 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.

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