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. Audit of sexual activity and risk-level status documentation. 321 0 obj <>stream Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. 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. l+PxF.wYh|:7#jvUF\A_Xr9Gs#C:Ynu,-,-AFk[,b5+"*,gbJW*;A[PA[r}Xq~jy!.N(7kF f This demonstrates that we do not viewyouth only in the risk context. 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. 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]). These funders played no role in the study design, analysis, or preparation of this article. CRAFFT is a valid substance use screening tool for the adolescent population. 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The majority of respondents reported they would be more likely to increase delivery of sexual health services if provided with further education.40 Clinicians expressed concerns about the acute nature of illness and injury in the ED and the sensitive nature of sexual activity screening. MI has been demonstrated to be feasible, effective, and a preferred method to change risky behavior across all risk behavior domains in ED and hospital settings.29,59,67 Specifically, the FRAMES acronym provides a promising framework for MI for adolescent substance use but can be applied to any high-risk behavior change.59 However, some adolescents may instead prefer paper materials or brochures over face-to-face counseling, so this presents an alternative option.38 As demonstrated in the McFadden et al25 study, other interventions to consider implementing in the ED and hospital settings include STI testing and treatment, contraceptive provision, HPV vaccination, and referral to subspecialty resources (both inpatient and outpatient). This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as . Comprehensive Adolescent Risk Behavior Screening Studies. The shorter versions of AUDIT (AUDIT-C and AUDIT-PC) failed to identify a significant proportion of adolescents with a positive AUDIT-10 result. A systematic review. ED clinicians acknowledged the importance of depression screening. The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of . 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. 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. We developed the rapid screening tool home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED), which is a modification of "HEADS," a mnemonic widely used to obtain a psychosocial . 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. 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. 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 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. The majority of ED physicians felt that the ED was an appropriate venue for screening and intervention on alcohol use disorders. 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. 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). 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. A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. The elements of sexual history most frequently documented were sexual activity (94%), condom use (48%), history of STIs (38%), number of sexual partners (19%), and age at first intercourse (7%). Risky behaviors are the main threats to adolescents health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. Of respondents, 76.5% preferred an electronic survey to face-to-face interviews. 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? Preventive oral health intervention for pediatricians. 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). We outline potential tools and approaches for improving adherence to guideline-recommended comprehensive screening and adolescent health outcomes. 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. Parents were overall supportive of sexual activity screening and care provision in the ED and hospital setting. 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]). 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. gogol bordello lawsuit update,