headss assessment american academy of pediatrics

Buy-in from physicians was difficult in the implementation phase. Pediatrics. Online Training for Healthcare Providers | HEADS UP - CDC 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). Copyright American Academy of Pediatrics. These brief validated tools within single risk behavior domains could potentially be combined into a single comprehensive screen (with consideration that these screening tools may have been validated for specific populations and plans to assess feasibility and time burdens). Please note, Internet Explorer is no longer up-to-date and can cause problems in how this website functionsThis site functions best using the latest versions of any of the following browsers: Edge, Firefox, Chrome, Opera, or Safari. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. 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. 10.1542/peds.2020-020610. The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI. 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. Newton Screen: 3 questions on substance use based on DSM5 aimed at adolescents (self-administered tablet tool with follow-up phone calls), Alcohol use disorder: sensitivity = 78.3%, specificity = 93%; cannabis use disorder: sensitivity = 93.1%, specificity = 93.5%. 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. 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. 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 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]). Protecting Children and Adolescents From Tobacco and Nicotine A concussion is a type of traumatic brain injury (TBI) that temporarily disrupts normal brain function. Adolescent Risk Behavior Screening and Interventions in Hospital They described targeted computer modules as interventions for adolescents who screen positive or, alternatively, use of a universal education intervention, such as a wallet-sized informational card. There were no studies on patient or parent attitudes toward substance use screening or interventions. Risk for pregnancy was high among adolescent patients in the ED, particularly for those with recent ED use and without a primary care provider. Approximately 4% of younger adolescents (aged 1315; The AUDIT-10 may be a less useful tool in the younger adolescent population (1315) compared with the older adolescent population (1617) given the low rate of positive screen results in the younger group. Three ED studies described interventions to increase comprehensive risk behavior screening. A computerized self-disclosure tool is a feasible way to collect sensitive adolescent data, and adolescents prefer self-disclosure methods and were willing to disclose sexual activity behaviors and receive STI testing, regardless of the chief complaint. 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. Oral health risk assessment timing and establishment of the dental home. RT @nancydoylebrown: David Leonhardt continues: "The effects were worst on low-income, Black and Latino children. If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. 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. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). The assessment starts with simple and easy questions about life to allow a . Of those who ended up needing it, 92% had answered yes before knowing. 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. Survey of female adolescent patients using ACA software. CRAFFT is a valid substance use screening tool for the adolescent population. 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. The Sexual Health Screen reported on by Goyal et al35 presents a feasible and valid way to screen for sexual and reproductive health. hmO0Qb1 BV`T!JkX&TI*u_~9M(*06*tgP.5VKd Early childhood is a pivotal period of child development that begins before birth through age 8. Survey to assess acceptability of sexual health discussion, STI testing, and pregnancy testing in the ED; verbal explanation of answers also obtained from participants. endstream endobj 323 0 obj <>stream The Ask Suicide Screening Questions (asQ) assesses patients with severe symptoms of depression. ASQ on a validated self-screening tablet tool. We report on evaluation of the network after 10 years of operation by reviewing program context, input, processes, and products to measure its progress in performing educational research that advances . The Newton Screen had better sensitivity for cannabis use and good specificity for both. 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. 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. For COVID related questions, please emailcovid-19@aap.org.For Mental Health related questions, please emailmentalhealth@aap.org.Brought to you by AAP Education. 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?. ADHD - Caring for Children With ADHD: A Practical Resource Toolkit for Although poverty increases the risk for mental health conditions, studies show that the greatest increase in prevalence occurred among children living in households earning greater than 400% above the federal poverty line. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. The FRAMES acronym tool can be used to outline brief interventions. 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. There were no studies on parent or clinician attitudes toward comprehensive risk behavior screening. 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. How Pediatricians Screen for Autism - HealthyChildren.org Abstract. 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. 2010;38(10):746-761; American Academy of Pediatrics Section on Pediatric Dentistry and Oral Health. We conducted a scoping review given expected heterogeneity of the body of literature on this topic. Six-five percent agreed to screening (. Feasibility of screening patients with nonpsychiatric complaints for suicide risk in a pediatric emergency department: a good time to talk? 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 Background and objective: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). A computerized psychosocial screening tool, such as the BHS-ED, may be a feasible intervention to increase detection of mental health problems in adolescent patients in the ED. A 2-question SI screen was piloted by Patel et al50 in an urgent care setting to identify adolescents at risk for SI. However, none of the patients screened positive for SI on the SIQ (comparison standard). A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. We outline potential tools and approaches for improving adherence to guideline-recommended comprehensive screening and adolescent health outcomes. The 2 reviewers made joint final decisions on inclusion of studies with conflicting initial determinations. Almost all patients deemed to have elevated suicide risk endorsed SI (SIQ-JR) and/or had a recent suicide attempt. 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. 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. HEADS UP to Health Care Providers: Tools for Providers Previous studies indicate low rates of risk behavior screening and interventions in ED and hospital settings. Learn Steps to Improve the Care of Your Pediatric Patients with mTBI. ED and Urgent Care Adolescent Risk Behavior Screening and Interventions. 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. Download ACE Care Plan - Work version ACE Care Plan - School version Comprehensive Adolescent Risk Behavior Screening Studies. Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? Only 1.2% used SBIRT consistently. The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. For cannabis use screening, the authors recommend using the DISC Cannabis Symptoms (1 question): In the past year, how often have you used cannabis: 0 to 1 time, 2 times? For alcohol use screening, the authors recommend using the DSM-IV 2-item scale: In the past year, have you sometimes been under the influence of alcohol in situations where you could have caused an accident or gotten hurt? Have there often been times when you had a lot more to drink than you intended to have?, Reviews epidemiology, screening, and MI and brief interventions for substance use. Current Concepts in Concussion: Initial Evaluation and Management The shorter versions of AUDIT (AUDIT-C and AUDIT-PC) failed to identify a significant proportion of adolescents with a positive AUDIT-10 result. 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. 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. The American Academy of Pediatrics (AAP) and other organizations recommend using this assessment in order to address risk behaviors. Confidentiality, consent, and caring for the adolescent patient, Digital health technology to enhance adolescent and young adult clinical preventive services: affordances and challenges, Copyright 2021 by the American Academy of Pediatrics, This site uses cookies. Documentation of sexual activity screening of adolescents was low in both ED and hospital settings. 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. Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. In the Supplemental Information, we outline the details of our search strategy. 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). 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.) 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. 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. Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. A majority of patients in the ED did not prefer EPT, and clinicians should address concerns if they do plan to prescribe EPT. Teenagers report wanting to receive pregnancy and STI preventive care in the ED, regardless of the reason to visit. 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. Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. Prevalence of IPV was 36.6% in screened patients. 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. 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. Sexual activity (patient and clinician attitudes), Computerized survey to assess acceptability and usefulness of a sexual health CDS system. 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. The developmental milestones are listed by month or year first because well-child visits are organized this way. A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. Barriers identified included time, concern about follow-up, and lack of 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%). 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 MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. More prospective controlled studies are needed to evaluate such interventions in ED and hospital settings. Sexual activity self-disclosure tool (ACASI). 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. Computerized health survey and guided decision-making tool for physicians in intervention arm. We did not combine and quantitatively analyze study results because of heterogeneity in study design. Next, the 2 reviewers independently completed a full-text screen. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. Self-administered BHS-ED: computerized survey to assess substance use, PTSD, exposure to violence, SI, and depression, During the implementation period, BHS-ED was offered to 33% of patients by clinical staff. . Two independent reviewers screened, extracted, and summarized the studies (N.P. *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 2022 PREP The Curriculum - AAP 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). All students are required to complete an observed HEADSS assessment over the course of their clerkship. This demonstrates that we do not viewyouth only in the risk context. Revisions: 7. 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. 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 . The 3rd edition of Caring for Children with ADHD: A Practical Resource Toolkit for Clinicians! PDF Pain Management in Infants, Children, Adolescents, and - AAPD MI-based brief intervention to assess sexual behaviors and provide personalized treatment (STI testing, contraception) and referral for follow-up care. 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). Female adolescents and parents were generally more supportive of mental health screening (other than suicide risk) than their male counterparts. Preventive oral health intervention for pediatricians. American Academy of Pediatrics Offers Guidance for Caring and Treatment of Long-Term Cancer Survivors Childhood Cancer Survivors: What to Expect After Treatment News Releases Policy Collections Advocacy The State of Children in 2020 Healthy Children Secure Families Strong Communities All children should wear masks in school this fall, even if vaccinated Details on risk level were frequently left out. Our study also highlights the general dearth of studies on the topic (only 7 studies in the hospital setting, only 2 studies with low risk of bias based on our analysis). Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. Assessment and Action | AAFP - American Academy of Family Physicians Screening for Social Determinants of Health Among Children and Families Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%).

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