headss assessment american academy of pediatrics

When patients screen positive for risky behaviors, it is imperative to have strategies and resources in place to address these behaviors. Positive themes included detection of youth who may be at risk and have a lack of social support as well as possible prevention of suicide attempts. For cannabis use screening, the authors recommend using the DISC Cannabis Symptoms (1 question): In the past year, how often have you used cannabis: 0 to 1 time, 2 times? For alcohol use screening, the authors recommend using the DSM-IV 2-item scale: In the past year, have you sometimes been under the influence of alcohol in situations where you could have caused an accident or gotten hurt? Have there often been times when you had a lot more to drink than you intended to have?, Reviews epidemiology, screening, and MI and brief interventions for substance use. 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. 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. Oral health risk assessment timing and establishment of the dental home. Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. Tools to aid. Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. 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. Self-administered tablet questionnaire: NIAAA 2-question screen (the 2 questions differed between high schoolaged and middle schoolaged adolescents). 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). Confidentiality, consent, and caring for the adolescent patient, Digital health technology to enhance adolescent and young adult clinical preventive services: affordances and challenges, Copyright 2021 by the American Academy of Pediatrics, This site uses cookies. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. 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. In 75% of cases in which risk behaviors were identified, interventions were provided. 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. Adolescents reported high rates of risky behaviors and interest in receiving interventions for these behaviors. These brief validated tools within single risk behavior domains could potentially be combined into a single comprehensive screen (with consideration that these screening tools may have been validated for specific populations and plans to assess feasibility and time burdens). 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. 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. The AAP, which said. 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. In the intervention arm, the results of the screen provided decision support for ED physicians. The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 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. Moderate to good test-retest reliability was found between questionnaire takers. There is a high unintended pregnancy risk in adolescents using the ED. 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. Adolescents prefer in-person counseling and target education (related to their chief complaint). 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. The ED visit may provide an opportunity to meet the contraceptive needs of adolescents, particularly for those who do not receive regular well care. Depression scales include the Patient Health Questionnaire 9 Modified for Adolescents (PHQ9M) and the Columbia Depression Scale can be administered universally to adolescents or used in a targeted population. 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). 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. A 2-question SI screen was piloted by Patel et al50 in an urgent care setting to identify adolescents at risk for SI. RCT, randomized controlled trial; , not present; +, present. Geopolitical boundaries do not circumscribe health issues and nowhere is this more obvious than in Los Angeles. We did not combine and quantitatively analyze study results because of heterogeneity in study design. Further study is warranted. Study design and risk of bias are presented in Table 1. Early childhood is a pivotal period of child development that begins before birth through age 8. Interview, primary question of interest (asked after standardized suicide screening): Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. 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. It is important to conduct adolescent substance use screening in the ED. High risk for SI was identified in 93.4% of yes respondents and in 84.5% of the no response group. 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. Copyright American Academy of Pediatrics. Further research is needed to assess the effectiveness of the CDS system in improving adolescent sexual health care. 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. 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 . 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). 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%). 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]). *0zx4-BZ8Nv4K,M(WqhQD:4P H!=sb&ua),/(4fn7L b^'Y):(&q$aM83a hdQT Nj'8PHla8K^8nLBs7ltJ2umZi96^p&)PZ?]3^$Zc`O;|462 L-{:ZA:JmGv?Hw(ibKWyK2>{)K_P/)g?\(E~&=wAez8nsM7bvE^#FUTd1"$73;ST\ao=7S[ddf(K$7v |(|w .AFX Survey eliciting sexual history, preferences for partner STI notification, and partner EPT. 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. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. 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. We report on a number of successful domain-specific screening tools validated in ED and hospital settings. 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. 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. 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. 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. Promising solutions include self-disclosure via electronic screening tools, educational sessions for clinicians, and clinician reminders to complete screening. The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! 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. 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 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 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. Already purchased? 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. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . Computerized survey to assess sexual history and interest in interventions in the ED. Almost all patients deemed to have elevated suicide risk endorsed SI (SIQ-JR) and/or had a recent suicide attempt. More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. Immediate intervention in the ED and receiving information for follow-up care were rated as the most helpful responses to a positive screening result. 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. Audit of sexual activity and risk-level status documentation. 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. 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). Using methods from a study by Rea et al,18 we analyzed risk of bias for each of the included studies and found that only 2of 46 studies had a low risk of bias, 33 of 46 had moderate risk of bias, and 11 of 46 had a high risk of bias. We only included studies published in English. In fact, in a study by Miller et al,39 parents were more accepting of sexual activity screening and STI testing than surveyed clinicians. Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. 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. In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. Survey of female adolescent patients using ACA software. CRAFFT is a valid substance use screening tool for the adolescent population. Of those who ended up needing it, 92% had answered yes before knowing. As physicians, we need to ask about the context of a teen's life, and the HEADSS assessment is a good guide. 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. However, many barriers to screening in the ED setting were reported. Investigates different SI screening tools used in ED. EC knowledge was poor among clinicians surveyed. Clinicians were comparatively less accepting, particularly if the visit was not related to sexual health. SI screening of all patients in the ED is feasible and acceptable to adolescent patients. Risk for pregnancy was high among adolescent patients in the ED, particularly for those with recent ED use and without a primary care provider. 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. 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 American Academy of Pediatrics (AAP) and other organizations recommend using this assessment in order to address risk behaviors. A majority of patients in the ED did not prefer EPT, and clinicians should address concerns if they do plan to prescribe EPT. 1, 6 Studies indicate that a majority (62%-70%) of adolescents do not have annual preventive care visits, and of those who do, only 40% report spending time alone with a Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. 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. 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). There was no difference in the median length of ED stay between those who completed the survey and those who did not. Two of the studies took place in the hospital setting and 4 in the ED setting. 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. Adolescents preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors? Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. One study that met inclusion criteria was found post hoc and included in the final review for a total of 46 studies (Fig 1). 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. Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). Only 1.2% used SBIRT consistently. 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. The majority of ED physicians felt that the ED was an appropriate venue for screening and intervention on alcohol use disorders. A systematic review. You can find the latest versions of these browsers at https://browsehappy.com. Pain assessment is an integral component of the dental history and comprehensive evaluation. Eighty-two percent of patients who screened positively were referred to outpatient mental health, and 10% were admitted to a psychiatric facility. 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). This fast movement can cause the brain to bounce around or twist in the skull, creating . 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. 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. Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. In this scoping review, we aim to comprehensively describe the extent and nature of the current body of research on risk behavior screening and risk behavior interventions for adolescents in urgent care, ED, and hospital settings. All rights reserved. In the hospital setting, the top 3 barriers to sexual activity screening among clinicians included concerns about follow-up (63%), lack of knowledge regarding contraception (59%), and time constraints (53%). Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. This demonstrates that we do not viewyouth only in the risk context. The studies in our review reveal ubiquitously low rates of risk behavior screening in the ED and hospital setting across all risk behavior domains.

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