headss assessment american academy of pediatrics

Download ACE Care Plan - Work version ACE Care Plan - School version Nora Pfaff, Audrey DaSilva, Elizabeth Ozer, Sunitha Kaiser; Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. The ASQ is a brief tool to assess suicide risk in pediatric patients in the ED and has a high sensitivity, specificity, and NPV. 321 0 obj <>stream Protecting Children and Adolescents From Tobacco and Nicotine Survey of 17 candidate suicide screening questions. 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. 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). 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. Further research is needed to assess the effectiveness of the CDS system in improving adolescent sexual health care. These funders played no role in the study design, analysis, or preparation of this article. 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. Also, most studies had limited durations of follow-up, so we cannot comment on long-term effects. 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]). Universal screening reduces missed opportunities to identify children who may have mental health conditions and promotes intervention aimed at preventing some of the long-term effects of a childhood mental disorder. 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. Almost all adolescents agreed that nurses should screen for suicide risk in the ED. The ACE (Acute Concussion Evaluation) forms are patient assessment tools. Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. 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. Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. 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. Four screening questions identified 99% of patients who had experienced IPV. A patient was more likely to have documentation if the note was written by an intern (, Sexual and menstrual history documentation. Two of the studies took place in the hospital setting and 4 in the ED setting. 10.1542/peds.2020-020610. Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. *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 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. The STI testing frequency (intervention) was higher in the intervention group (52.3% vs 42%; OR 2.0 [95% CI 1.13.8]) and in asymptomatic patients (28.6% vs 8.2%; OR 4.7 [95% CI 1.415.5]). 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? H&P, history and physical; IUD, intrauterine device. A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. Comprehensive Adolescent Risk Behavior Screening Studies. Current Concepts in Concussion: Initial Evaluation and Management 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. In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (10%) but significant increases with clinician reminder implementation. The ED is an opportunity to screen adolescents for SI, and there are numerous (although some not validated in a hospital setting) tools that can be used for screening despite no consistent recommendations for universal screening. An additional 28% had partial or incomplete screening, with less sensitive issues, such as home life, education, and employment, documented significantly more often than sexual activity, depression, or drug use (P = .013). Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. A significant proportion of adolescents who screened positive for elevated suicide risk in the ED were presenting for nonpsychiatric reasons. 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. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. HEADSS: The "Review of Systems" for Adolescents Mental health is an essential component of overall health. 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. We acknowledge Evans Whitaker, MD, MLIS, for his assistance with the literature search. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Our findings can help guide efforts in these settings to advance screening and interventions for risk behaviors, thereby improving health outcomes for adolescents. 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. 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 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. Reported barriers were time constraints and limited resources. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). ED-DRS, Emergency Department Distress Response Screener. Seven studies on substance use screening and intervention were included in our review; all took place in the ED setting (Table 4). Risky behaviors present a great threat to adolescent health and safety and are associated with morbidity into adulthood.1,2 Unintended pregnancy, sexually transmitted infections (STIs), substance use, suicide, and injury are the primary causes of morbidity and mortality in those aged 10 to 24 years.3 Risky behaviors are prevalent among US high school students, with 35% reporting alcohol use, 23% reporting marijuana use, and 47% reporting sexual activity (but only 59% reporting using a condom during their last sexual encounter).1 Consequently, the American Academy of Pediatrics recommends comprehensive risk behavior screening at annual preventive care visits during adolescence,4 with the goal of identifying risk behaviors and providing risk behaviorrelated interventions (eg, STI testing).5. MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. 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. 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. 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. Adolescents reported interest in receiving education about sexual health topics, such as STIs, contraception, and HIV, in the ED. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. 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. 2010;38(10):746-761; American Academy of Pediatrics Section on Pediatric Dentistry and Oral Health. 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 Concussions: What Parents Need to Know - HealthyChildren.org . h222W0Pw/+Q0,H/-K-0 = 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?. This demonstrates that we do not viewyouth only in the risk context. IMPACT Program | Children's Hospital Los Angeles Semistructured focus groups covering thoughts and experience with EC; written survey to assess EC knowledge. 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%).

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