Three ED studies described interventions to increase comprehensive risk behavior screening. The purpose of this exercise is to provide medical students an opportunity to practice their skills performing a HEADSS assessment with an adolescent standardized patient through video conferencing. 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. Semistructured focus groups covering thoughts and experience with EC; written survey to assess EC knowledge. 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 For intimate partner violence and adolescent relationship abuse, Jackson et al63 outline successful outpatient interventions (eg, universal wallet-sized educational cards and targeted computerized interventions) that could be feasible in the ED setting but would require further investigation. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. In fact, in a study by Miller et al,39 parents were more accepting of sexual activity screening and STI testing than surveyed clinicians. 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. There was no difference in the median length of ED stay between those who completed the survey and those who did not. There were no studies on patient or parent attitudes toward substance use screening or interventions. This IMPACT project analyzes which factors are associated with HEADSS assessment completion and aims . The American Academy of Pediatrics (AAP) and other organizations recommend using this assessment in order to address risk behaviors. Of those who ended up needing it, 92% had answered yes before knowing. Copyright 2023 American Academy of Pediatrics. Data extracted from the full texts included the full citation, study type, risk of bias, risk behavior domain, intervention or screening tool, results of the study, and conclusions. Promising methods to increase screening rates include self-disclosure electronic screening tools coupled with reminders for clinicians (paper or within the EHR). Therefore, lower positive result screen cutoff scores may be necessary when using the AUDIT-C or AUDIT-PC in the adolescent population. Within each category, we grouped studies by subcategory: screening rates, screening and intervention tools, and attitudes toward screening and intervention. 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. The 2 reviewers made joint final decisions on inclusion of studies with conflicting initial determinations. The value of such interaction was echoed in another study in which patients preferred in-person counseling.37 However, in a cross-sectional hospital study, Guss et al38 found that patients who were interested in more information preferred learning about contraceptive options from a brochure rather than from a clinician. An MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. Further research is needed to assess the effectiveness of the CDS system in improving adolescent sexual health care. If your child is alert and responds to you, the head injury is mild and usually no tests or X-rays are needed. Four screening questions identified 99% of patients who had experienced IPV. 2003; 122(6):1387-1394; and American Academy of Pediatrics Section of Pediatric Dentistry. %PDF-1.7 % 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. 2010;38(10):746-761; American Academy of Pediatrics Section on Pediatric Dentistry and Oral Health. SI screening of all patients in the ED is feasible and acceptable to adolescent patients. 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. Female adolescents showed preference for in-person counseling, from a person of authority (doctor, nurse) rather than from a peer counselor. More than half (56%) of hospitalists reported regularly taking sexual history but rarely provided condoms or a referral for IUD placement. Copyright American Academy of Pediatrics. Survey of 17 candidate suicide screening questions. 321 0 obj <>stream 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. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. 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. Falcn et al61 found that, during implementation of a standardized screening program, it was important to minimize workflow disruption and provide adequate education to achieve participant buy-in. 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 . A model of 4 candidate questions (ASQ) was found to have a sensitivity of 96.9%, a specificity of 87.6%, and an NPV of 99.7%. Survey to assess sexual history, sexual health knowledge, and desire for sexual health education. programs for many years.3The rationale behind the modification includes It begins with strengths. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). Youth who select no response are at elevated risk of SI and may warrant further screening and/or evaluation. Less than half of admitted patients had documented menstrual (32.8%) or sexual history (45.9%). 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. 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. Many adolescents felt the ED should universally provide education on sexual and reproductive health practices and provide contraceptive services, especially for patients who may not have access to a primary provider.25,3032 Chernick et al33 found that one-fourth of the adolescent patients in their study were interested in receiving contraception in the ED. h222W0Pw/+Q0,H/-K-0 = Our data sources included PubMed (19652019) and Embase (19472019). The assessment starts with simple and easy questions about life to allow a . With the heterogeneity of studies included, we could only summarize findings but could not perform a meta-analysis. In the intervention arm, the results of the screen provided decision support for ED physicians. When implementing an alcohol use screening and/or intervention program for adolescents in the ED, it is important to minimize workflow disruption caused by the program and provide adequate education to achieve staff participation. Geopolitical boundaries do not circumscribe health issues and nowhere is this more obvious than in Los Angeles. Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. *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 . For more educational content visitwww.pedialink.org. After duplicates were removed, 1867 unique studies were identified. Early childhood is a pivotal period of child development that begins before birth through age 8. The ASQ is a brief tool to assess suicide risk in pediatric patients in the ED and has a high sensitivity, specificity, and NPV. Sexual activity self-disclosure tool (ACASI). Documentation of sexual history in hospitalized adolescents on the general pediatrics service, Addressing reproductive health in hospitalized adolescents-a missed opportunity, Documentation of sexual and menstrual histories for adolescent patients in the inpatient setting, Sexual-history taking in the pediatric emergency department, A computerized sexual health survey improves testing for sexually transmitted infection in a pediatric emergency department, Brief behavioral intervention to improve adolescent sexual health: a feasibility study in the emergency department, Examining the role of the pediatric emergency department in reducing unintended adolescent pregnancy, A pilot study to assess candidacy for emergency contraception and interest in sexual health education in a pediatric emergency department population, Factors associated with interest in same-day contraception initiation among females in the pediatric emergency department, Identifying adolescent females at high risk of pregnancy in a pediatric emergency department, Characteristics of youth agreeing to electronic sexually transmitted infection risk assessment in the emergency department, Development of a sexual health screening tool for adolescent emergency department patients, Preferences for expedited partner therapy among adolescents in an urban pediatric emergency department: a mixed-methods study [published online ahead of print March 14, 2019], Developing emergency department-based education about emergency contraception: adolescent preferences, Using the hospital as a venue for reproductive health interventions: a survey of hospitalized adolescents, Acceptability of sexual health discussion and testing in the pediatric acute care setting, Adolescent reproductive health care: views and practices of pediatric hospitalists, Pediatric emergency health care providers knowledge, attitudes, and experiences regarding emergency contraception, Development of a novel computerized clinical decision support system to improve adolescent sexual health care provision, Utility of the no response option in detecting youth suicide risk in the pediatric emergency department, Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department, Adolescent suicide risk screening in the emergency department. EC knowledge was poor among clinicians surveyed. Further study of technology-based behavioral interventions is warranted. 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. A sexual health screening electronic tool was acceptable to patients and feasible in terms of workflow in the ED. 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. All students are required to complete an observed HEADSS assessment over the course of their clerkship. 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 screening tool is a standardized set of questions used to identify issues in a child that require further investigation. 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. 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. Behavioral Health ScreeningEmergency Department, Diagnostic Interview Schedule for Children, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, feedback, responsibility, advice, menu, empathy, self-efficacy, home, education, activities, drugs, sexual activity, suicide and/or mood, screening, brief intervention, and referral to treatment. 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. Previous studies indicate low rates of risk behavior screening and interventions in ED and hospital settings. Inclusion criteria were study population age (adolescents aged 1025 years), topic (risk behavior screening or risk behavior interventions), and setting (urgent care, ED, or hospital). Most adolescents and parents rated screening for suicide risk and other mental health problems in the ED as important. Six of 46 studies that were included in our review were focused on comprehensive risk behavior screening and/or interventions (across all risk behavior domains), as summarized in Table 2. No charts contained documentation on other important risk-stratifying details, such as contraception use other than condoms, the sex of partners, partners risk of STIs, anal sex practice, or partners drug use.27 None of these studies reported on whether privacy was ensured in sexual history taking, although they did mention the need for confidentiality as a possible barrier to higher rates of screening.2326, McFadden et al25 described sexual health services provided in the hospital setting and reported that STI testing was conducted in 12% of patients, that pregnancy testing was done in 60% of female patients, and that contraception was provided for 2% of patients. In an ED survey study by Ranney et al,23 for all risk behavior categories assessed, 73% to 94% of adolescent patients (n = 234) were interested in interventions, even when screen results were negative. 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]). Even patients with a current primary care provider and those who were not sexually active were interested in inpatient interventions. 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]). Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? 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. 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. 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]). We report on a number of successful domain-specific screening tools validated in ED and hospital settings. 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 RSQ could not be validated in an asymptomatic population of adolescents and was noted to have a high false-positive rate in this low-risk population (recommended doing more general HEADSS screening). 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.
When A Member Is No Longer Qualified For Advancement,
Startup Distillery Spreadsheets,
Tommie Hotel Hollywood,
Articles H
