Six-five percent agreed to screening (. 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. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. 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. Comprehensive Adolescent Risk Behavior Screening Studies. Dr Pfaff conceptualized and designed the study, conducted the literature search, screened literature for inclusion, extracted data from included studies, and drafted and edited the manuscript; Dr DaSilva helped in study design, conducted the literature search, screened literature for inclusion, extracted data, and helped with drafting the original manuscript; Dr Ozer helped in study design, editing and revising the manuscript, and critically appraising the manuscript content; Dr Kaiser supervised the conceptualization and design of the study, supervised the data extraction from the included literature, and helped in revising and editing the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Details on risk level were frequently left out. Cohens was calculated and determined to be 0.8, correlating with a 90.7% agreement. They found that the risk of intimate partner violence in female adolescents who presented to the ED was high (37%) and that 4 screening questions had 99% sensitivity.62. ED physicians used SBIRT in limited and nonstandardized ways. The Vanderbilt rating scale assesses symptoms of attention deficit disorder as well as oppositional and anxious behaviors. 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. Questionnaire used to assess beliefs regarding screening and intervention for suicide risk and other mental health problems in the ED. 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. However, none of the patients screened positive for SI on the SIQ (comparison standard). %PDF-1.7 % The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. 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. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. Tools to aid. Welcome to HEADS-ED. All rights reserved. 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. Sexual activity (patient and clinician attitudes), Computerized survey to assess acceptability and usefulness of a sexual health CDS system. Promising methods to increase screening rates include self-disclosure electronic screening tools coupled with reminders for clinicians (paper or within the EHR). A majority of participants (85%) felt the ED should provide information on contraception, and 65% believed the ED should provide safe sex and pregnancy prevention services at all ED visits. 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. Buy-in from physicians was difficult in the implementation phase. Immediate intervention in the ED and receiving information for follow-up care were rated as the most helpful responses to a positive screening result. It appears you are using Internet Explorer as your web browser. 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. 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. In the ED, researchers of a single-blind randomized controlled trial tested a computerized self-administered screening tool to identify adolescent patients who were at risk for STIs. Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent? There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. 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. MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. 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. Reported barriers were time constraints and limited resources. 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 significant proportion of adolescents who screened positive for elevated suicide risk in the ED were presenting for nonpsychiatric reasons. Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. Interview, primary question of interest: Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. 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?. 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. Two of the studies took place in the hospital setting and 4 in the ED setting. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). However, many barriers to screening in the ED setting were reported. Four screening questions identified 99% of patients who had experienced IPV. 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. Survey to assess sexual history, sexual health knowledge, and desire for sexual health education. 28 Apr 2023 20:21:28 If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. We described and summarized major findings, organized by the following risk behavior categories: comprehensive, sexual activity, mood and suicidal ideation (SI), substance use, and abuse and violence. Moderate to good test-retest reliability was found between questionnaire takers. Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. Risk for pregnancy was high among adolescent patients in the ED, particularly for those with recent ED use and without a primary care provider. MI avoids confrontation, and the authors note that both of these evidence-based tools work with a patients readiness to change and build awareness of the problem, resulting in increased self-efficacy for the adolescent.59. 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. 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]). 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]). For mood and SI screening, validated tools include the ASQ and RSQ.48,53 For substance use screening, potential tools include the Newton Screen, the National Institute of Alcohol Abuse and Alcoholism 2-question screen, and SBIRT.56,58,66 For intimate partner violence screening, Erickson et al62 validated the 8-item Conflict Tactics Survey. Mental health is an essential component of overall health. 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. Next, the 2 reviewers independently completed a full-text screen. The AAP designates this enduring material for a maximum of 40.00 AMA PRA Category 1 Credit (s). A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. The ACE (Acute Concussion Evaluation) forms are patient assessment tools. Our initial search yielded 1336 studies in PubMed and 656 studies in Embase. RT @nancydoylebrown: David Leonhardt continues: "The effects were worst on low-income, Black and Latino children. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Most adolescents have few physical health problems, so their medical issues come from risky behaviors. 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). Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. The use of standardized screening tools by pediatric providers is more effective in the identification of developmental, behavioral and psychosocial issues in children than clinical assessments alone. 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. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. 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. 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. 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. l+PxF.wYh|:7#jvUF\A_Xr9Gs#C:Ynu,-,-AFk[,b5+"*,gbJW*;A[PA[r}Xq~jy!.N(7kF f 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. Eighty-two percent of patients who screened positively were referred to outpatient mental health, and 10% were admitted to a psychiatric facility. The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. ASQ on a validated self-screening tablet tool. Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus 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. 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. Revisions: 7. 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.) For more educational content visitwww.pedialink.org. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . 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. 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. To access log in and visit Three ED studies described interventions to increase comprehensive risk behavior screening. 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. Four screening questions can capture patients at risk for IPV: Have you felt unsafe in past relationships? Is there a partner from a previous relationship that is making you feel unsafe now? Have you been physically hit, kicked, shoved, slapped, pushed, scratched, bitten, or otherwise hurt by your boyfriend or dating partner when they were angry? Have you ever been hurt by a dating partner to the point where it left a mark or bruise?, Narrative review to explore ARA identification and intervention in the ED. We excluded studies that involved outpatient follow-up of patients to evaluate interventions that could be completed in the ED or hospital setting, but this may have limited our review of more longitudinal effects. 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 (. A sexual health CDS system for adolescents in the ED received high acceptability and usability ratings from ED clinicians and adolescents. 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. Of those, 47% endorsed sexual activity. The majority of ED physicians felt that the ED was an appropriate venue for screening and intervention on alcohol use disorders. One study that met inclusion criteria was found post hoc and included in the final review for a total of 46 studies (Fig 1). Fewer than half of respondents used a validated tool when screening for alcohol use. In several of the included studies in the sexual activity domain, researchers looked at attitudes of adolescent patients, parents, and clinicians toward adolescents being screened in acute care settings. Computer-based interventions for adolescents who screen positive for ARA, as well as universal education in the form of wallet-sized cards, are promising and could be successful in the ED setting. Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic | Pediatrics | JAMA Network Open | JAMA Network This cohort study examines whether the use of surgical face masks among children was associated with changes in respiratory function or signs of respiratory dis [Skip to Navigation] .Z\S(?CvRx(6?X8TTnY-k!/.~zNV?-.,/O]b1:z>=Z. 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. Twelve studies on mood and SI screening and intervention were included in our review; 11 took place in the ED setting, and 1 took place in the urgent care setting (Table 4). The Academic Pediatric Association (APA) and the American Academy of Pediatrics (AAP) recently authorized task forces to address child poverty.8As a work-group of the APA Childhood Poverty Task Force Health Care Delivery Committee, we provide an evidence-based, practical approach to those aspects of surveillance and screening that apply
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