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. The studies in our review reveal ubiquitously low rates of risk behavior screening in the ED and hospital setting across all risk behavior domains. FUNDING: Dr Kaiser is supported by grants from the Agency for Healthcare Research and Quality (K08HS024592 and R03HS027041). Sexual activity self-disclosure tool (ACASI). hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd Copyright American Academy of Pediatrics. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus limiting generalizability. However, many barriers to screening in the ED setting were reported. Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. Protecting Children and Adolescents From Tobacco and Nicotine 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 ASQ on a validated self-screening tablet tool. There is a high unintended pregnancy risk in adolescents using the ED. endstream endobj 323 0 obj <>stream For a preterm baby, it is important to use the baby's adjusted age when tracking development until 2 years of age so that his growth and progress take into account that he was born early. 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. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? We report on a number of successful domain-specific screening tools validated in ED and hospital settings. In fact, in a study by Miller et al,39 parents were more accepting of sexual activity screening and STI testing than surveyed clinicians. Concussions: What Parents Need to Know - HealthyChildren.org To access log in and visit 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). High risk for SI was identified in 93.4% of yes respondents and in 84.5% of the no response group. Adolescents preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors? One study that met inclusion criteria was found post hoc and included in the final review for a total of 46 studies (Fig 1). Adolescents expressed that screening could lead to identification, prevention, and treatment of suicidal behavior. We acknowledge Evans Whitaker, MD, MLIS, for his assistance with the literature search. 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? It is important to conduct adolescent substance use screening in the ED. programs for many years.3The rationale behind the modification includes It begins with strengths. It appears you are using Internet Explorer as your web browser. of Items and Format Age-group and Any Languages / Reading Level if Specified Administration and Scoring Time Training a Source Initial Psychosocial Assessment (Algorithm Step 2): Previsit or Intra -visit Data Collection and Screening Surveillance 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. To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. 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. 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 their study, Erickson et al62 described screening and intervention regarding abuse or violence, specifically focusing on evaluating risk of intimate partner violence with an 8-item screening tool (the Conflict Tactics Survey). The Newton Screen may be a good brief screening tool for assessing alcohol and cannabis use. 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. 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. IMPACT Program | Children's Hospital Los Angeles For more educational content visitwww.pedialink.org. More recently, researchers evaluated a self-administered 3-item screening tool based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the Newton Screen, concluding that it was a brief and effective tool for screening both alcohol (sensitivity of 78.3% and specificity of 93%) and cannabis use (sensitivity of 93.1% and specificity of 93.5%).56, In a study on the use of the Alcohol Use Disorder Identification Test (AUDIT) tool, researchers observed differences in sensitivity based on the age group of adolescents, noting lower utility in younger adolescents.57 The National Institute of Alcohol Abuse and Alcoholism 2-question screen, a self-administered tool via tablet that features 2 different questions for middle schoolaged versus high schoolaged adolescents, was found to be a valid and brief way to screen for alcohol use in the ED.58, For positive screen results, MI and brief intervention tools, such as the FRAMES acronym (feedback, responsibility, advice, menu, empathy, self-efficacy) have been found to be effective in addressing high-risk behaviors, particularly in adolescent patients. 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. 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. 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. HEADS UP to Healthcare Providers is a free online training developed by CDC and the American Academy of Pediatrics. Less than half of admitted patients had documented menstrual (32.8%) or sexual history (45.9%). Most adolescents have few physical health problems, so their medical issues come from risky behaviors. 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 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. Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent? MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. The majority of ED physicians felt that the ED was an appropriate venue for screening and intervention on alcohol use disorders. .Z\S(?CvRx(6?X8TTnY-k!/.~zNV?-.,/O]b1:z>=Z. Welcome to HEADS-ED. PDF Pain Management in Infants, Children, Adolescents, and - AAPD The shorter versions of AUDIT (AUDIT-C and AUDIT-PC) failed to identify a significant proportion of adolescents with a positive AUDIT-10 result. Details on risk level were frequently left out. The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). Moderate to good test-retest reliability was found between questionnaire takers. A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. HEADSS UP: Predictors for Completion of Adolescent Psychosocial Two of the studies took place in the hospital setting and 4 in the ED setting. The ACE (Acute Concussion Evaluation) forms are patient assessment tools. We only included studies published in English.