Mental health is an essential component of overall health. 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. Further study is warranted. 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. After a title and abstract screen, 75 studies remained. Investigates different SI screening tools used in ED. Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. 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. A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. 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. 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. The ACE (Acute Concussion Evaluation) forms are patient assessment tools. Documentation of reproductive health and inpatient delivery of reproductive health services (STI testing and/or treatment, HPV vaccination, and contraceptive provision), Documentation: Fifty-five percent of patients had sexual history documentation. The studies in our review reveal ubiquitously low rates of risk behavior screening in the ED and hospital setting across all risk behavior domains. 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). ED and Urgent Care Adolescent Risk Behavior Screening and Interventions. We only included studies published in English. More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. However, rates of e-cigarette and similar device use among youth are high, and rates of other tobacco product use, such as cigars and hookahs, have not declined. In the intervention arm, the results of the screen provided decision support for ED physicians. If your child is alert and responds to you, the head injury is mild and usually no tests or X-rays are needed. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. .Z\S(?CvRx(6?X8TTnY-k!/.~zNV?-.,/O]b1:z>=Z. 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. Computerized survey to assess sexual history and interest in interventions in the ED. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. 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. and A.D.). Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established. 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. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). In 75% of cases in which risk behaviors were identified, interventions were provided. The 2 reviewers made joint final decisions on inclusion of studies with conflicting initial determinations. A significant percentage of sexually active adolescents surveyed were potential candidates for EC. The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! Survey of hospitalists to assess beliefs and practices surrounding sexual and reproductive health screening and interventions. Overall risk of bias was as follows: low, 1 variable not present; moderate, 23 variables not present; and high, 45 variables not present. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? 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. Prevalence of IPV was 36.6% in screened patients. Similarly, in a hospital study of surgical adolescent patients by Wilson et al,19 the authors found that only 16% of patients were offered screening, and of these, 30% required interventions. When patients screen positive for risky behaviors, it is imperative to have strategies and resources in place to address these behaviors. Paper questionnaire to assess sexual activity, pregnancy or desire for pregnancy, interest in receiving sexual health interventions in the ED, and use of health care, Thirteen percent of surveyed adolescents (. This fast movement can cause the brain to bounce around or twist in the skull, creating . 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 . A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. Health risk behaviors in adolescents with chronic conditions, Health risk screening in adolescents: room for improvement in a tertiary inpatient setting, Hospital readmission of adolescents and young adults with complex chronic disease, Systematic review or scoping review? E-mail: Search for other works by this author on: Achieving quality health services for adolescents, Centers for Disease Control and Prevention, Opportunistic adolescent health assessment in the child protection unit, Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? Adolescents expressed that screening could lead to identification, prevention, and treatment of suicidal behavior. This demonstrates that we do not viewyouth only in the risk context. 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. Revisions: 7. ED clinicians acknowledged the importance of depression screening. Survey of female adolescent patients using ACA software. All rights reserved. Fifty-seven percent of female adolescents answered that adolescents should be offered contraception in the inpatient setting (no significant difference in response between self-reported sexually active and nonactive patients). The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. Learn Steps to Improve the Care of Your Pediatric Patients with mTBI. 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. 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). Most clinicians agreed that computerized depression screening could be a suitable approach to address many of the identified barriers to screening. Forty-six percent of patients were due for the human papillomavirus (HPV) vaccine, and 19% of these received it during admission.25. Address correspondence to Nora Pfaff, MD, Department of Pediatrics, University of California, San Francisco Benioff Childrens Hospital, 550 16th St, 5th Floor, San Francisco, CA 94143. Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. 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. 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. 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. HEADS UP to Healthcare Providers is a free online training developed by CDC and the American Academy of Pediatrics. Scoping reviews map out broad themes and identify knowledge gaps when the published works of focus use a wide variety of study designs.15 We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to inform our search and synthesis of the literature.16. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. A concussion is a type of traumatic brain injury (TBI) that temporarily disrupts normal brain function. 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 ED visit may provide an opportunity to meet the contraceptive needs of adolescents, particularly for those who do not receive regular well care. The value of such interaction was echoed in another study in which patients preferred in-person counseling.37 However, in a cross-sectional hospital study, Guss et al38 found that patients who were interested in more information preferred learning about contraceptive options from a brochure rather than from a clinician. 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. Download ACE Care Plan - Work version ACE Care Plan - School version In this study, the terms hospitalized or hospital setting refer to patients admitted to pediatric units under either inpatient or observation status. 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 Barriers identified included time, concern about follow-up, and lack of knowledge. 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. 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]). 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. 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. Our findings can help guide efforts in these settings to advance screening and interventions for risk behaviors, thereby improving health outcomes for adolescents. Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. 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). 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). Immediate intervention in the ED and receiving information for follow-up care were rated as the most helpful responses to a positive screening result. h222W0Pw/+Q0,H/-K-0 =
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. Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus limiting generalizability. Eighty-two percent of patients who screened positively were referred to outpatient mental health, and 10% were admitted to a psychiatric facility. RCT, randomized controlled trial; , not present; +, present. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. 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. Headache is the most common symptom. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. 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. A patient was more likely to have documentation if the note was written by an intern (, Sexual and menstrual history documentation. For COVID related questions, please emailcovid-19@aap.org.For Mental Health related questions, please emailmentalhealth@aap.org.Brought to you by AAP Education. A limitation of this scoping review is heterogeneity in the design and quality of the included studies, with only 1 randomized controlled trial in our area of focus. Teenagers report wanting to receive pregnancy and STI preventive care in the ED, regardless of the reason to visit. Our findings outline promising tools for improving screening and intervention, highlighting the critical need for continued development and testing of interventions in these settings to improve adolescent care. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. SI screening of all patients in the ED is feasible and acceptable to adolescent patients. Three ED studies described interventions to increase comprehensive risk behavior screening. 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). This IMPACT project analyzes which factors are associated with HEADSS assessment completion and aims . 10.1542/peds.2020-020610. The authors reported screening rates of 55% to 62%.24,25 For patients who had documented sexual or reproductive history, screening for more specific risk behaviors (such as condom use, birth control use, and number of sexual partners) was often omitted.24, Similarly, in the ED, a retrospective study by Beckmann and Melzer-Lange27 reported that even in charts of patients diagnosed with an STI, documentation of sexual activity was incomplete and inconsistent. The developmental milestones are listed by month or year first because well-child visits are organized this way. 28 Apr 2023 20:21:28 A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. 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]). The American Academy of Pediatrics recommends that clinicians screen adolescents for substance use and, if applicable, provide a brief intervention, establish follow-up, and consider referral. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. In the full-text screen, both reviewers included 43 studies and excluded 25 studies; 7 studies were in conflict. Documentation of sexual activity screening of adolescents was low in both ED and hospital settings. After duplicates were removed, 1867 unique studies were identified. Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. 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). Two independent reviewers screened, extracted, and summarized the studies (N.P. 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 . H&P, history and physical; IUD, intrauterine device. 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. The RSQ, a verbal 4-question suicide screening instrument, Twenty-two percent of patients screened positive on the RSQ. Less than half of admitted patients had documented menstrual (32.8%) or sexual history (45.9%). 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.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 clinician during the visit to address risk behaviors.7,8 Screening for risk behaviors confidentially is crucial to disclosure of engagement in risky behavior and also increases future likelihood of patients seeking preventive care and treatment.9 An estimated 1.5 million adolescents in the United States use EDs as their main source of health care,10 and these adolescents are more likely to come from vulnerable and at-risk populations.11 Additionally, risky behaviors and mental health disorders are prevalent among teenagers with chronic illnesses, a group that accounts for a significant proportion of hospitalized adolescents.1214 These findings underscore the need to perform risk behavior screening and interventions, such as STI testing and treatment, motivational interviewing (MI), and contraception provision, in ED and hospital settings.
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