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. Sexual activity self-disclosure tool (ACASI). 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. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. However, many barriers to screening in the ED setting were reported. Details on risk level were frequently left out. Clinicians were comparatively less accepting, particularly if the visit was not related to sexual health. Depression increased, and the American Academy of Pediatrics declared a national emergency in children's mental health." (And to think we called you racist for pleading for open schools.) 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. 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 HEADSSS assessment is an internationally recognised tool used to structure the assessment of an adolescent patient, encompassing H ome, E ducation/ E mployment, A ctivities, D rugs, S ex and relationships, S elf harm and depression, S afety and abuse. 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. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? Fewer than half of respondents used a validated tool when screening for alcohol use. The majority of respondents reported they would be more likely to increase delivery of sexual health services if provided with further education.40 Clinicians expressed concerns about the acute nature of illness and injury in the ED and the sensitive nature of sexual activity screening. Behavioral Health ScreeningEmergency Department, Diagnostic Interview Schedule for Children, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, feedback, responsibility, advice, menu, empathy, self-efficacy, home, education, activities, drugs, sexual activity, suicide and/or mood, screening, brief intervention, and referral to treatment. Download ACE Care Plan - Work version ACE Care Plan - School version An MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. 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. Adolescents prefer in-person counseling and target education (related to their chief complaint). A concussion is a type of traumatic brain injury (TBI) that temporarily disrupts normal brain function. American Academy of Pediatrics Page of Tools and Descriptions No. EC knowledge was poor among clinicians surveyed. Headache is the most common symptom. Adolescent Risk Behavior Screening and Interventions in the Hospital Setting. The developmental milestones are listed by month or year first because well-child visits are organized this way. A majority of patients in the ED did not prefer EPT, and clinicians should address concerns if they do plan to prescribe EPT. 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). The Newton Screen may be a good brief screening tool for assessing alcohol and cannabis use. 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,. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. hZkoG+!!E@@ (a02Zga%soUOO{R"'z{[M
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13-20% of children in the U.S. experience a mental health disorder each year. 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. Already purchased? Buy-in from physicians was difficult in the implementation phase. Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. In 75% of cases in which risk behaviors were identified, interventions were provided. Although comprehensive risk behavior screens (eg, the American Academy of Pediatrics Bright Futures64 and HEADSS3,65) remain the gold standard, they have not been validated in the ED or hospital setting. RT @nancydoylebrown: David Leonhardt continues: "The effects were worst on low-income, Black and Latino children. The NIAAA 2-question screen is a valid and brief way to screen for alcohol use in pediatric EDs. There were no studies on patient or parent attitudes toward substance use screening or interventions. Nineteen studies on sexual activity screening and/or intervention were included in our review: 5 in the hospital setting (Table 3) and 14 in the ED (Table 4). There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. All rights reserved. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Cohens was calculated and determined to be 0.8, correlating with a 90.7% agreement. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. Self-administered tablet questionnaire: NIAAA 2-question screen (the 2 questions differed between high schoolaged and middle schoolaged adolescents). 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). Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. Tools to aid. 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. 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. The shorter versions of AUDIT (AUDIT-C and AUDIT-PC) failed to identify a significant proportion of adolescents with a positive AUDIT-10 result. Study design and risk of bias are presented in Table 1. 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. Most adolescents who screened positive did not have mental healthrelated chief complaints, and positive screening results led to interventions in the form of referrals (82% of positive screen results) or urgent admission to an inpatient psychiatric facility (10% of positive screen results). CRAFFT is a valid substance use screening tool for the adolescent population. 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?. 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. Dr Ozer is supported by grants from the Health Resources and Services Administration of the US Department of Health and Human Services and the Maternal and Child Health Bureau under cooperative agreement UA6MC27378 and Maternal and Child Health Bureau Leadership Education in Adolescent Health Training grant T71MC00003. The studies in our review reveal ubiquitously low rates of risk behavior screening in the ED and hospital setting across all risk behavior domains. Your child's doctor will want to know when and how the injury happened and how your child is feeling. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. The Newton Screen had better sensitivity for cannabis use and good specificity for both. Semistructured interviews of clinicians to assess perceptions of depression in the adolescent population and thoughts about screening for depression in the ED. A significant proportion of adolescents who screened positive for elevated suicide risk in the ED were presenting for nonpsychiatric reasons. Sexual history documentation was incomplete in charts of adolescents discharged from the ED with STI diagnosis. The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (10%) but significant increases with clinician reminder implementation. The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. To access log in and visit Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus limiting generalizability. Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). Survey of female adolescent patients using ACA software. hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd Survey of 17 candidate suicide screening questions. 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. Female adolescents and parents were generally more supportive of mental health screening (other than suicide risk) than their male counterparts. The RSQ could not be validated in an asymptomatic population of adolescents and was noted to have a high false-positive rate in this low-risk population (recommended doing more general HEADSS screening). It is important to conduct adolescent substance use screening in the ED. 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. Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. 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.
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