PDF Oral Health Risk Assessment Tool - AAP ED physicians and NPs were more likely than nurses to support providing adolescents with EC, but most did not agree with routine screening for EC need in the ED. 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 a qualitative study, researchers assessed ED physician use of screening, brief intervention, and referral to treatment (SBIRT) and found that <50% of respondents used a validated tool when screening for alcohol use.60 Common perceived barriers were time constraints, inadequate staffing, lack of knowledge of screens, and concerns about parents reactions to screening. 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. In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. A significant proportion of adolescents were interested in starting contraception in the ED. 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). ED and Urgent Care Adolescent Risk Behavior Screening and Interventions. We only included studies published in English. Buy-in from physicians was difficult in the implementation phase. 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. 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. However, rates of e-cigarette and similar device use among youth are high, and rates of other tobacco product use, such as cigars and hookahs, have not declined. The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. Your Preemie's Growth & Developmental Milestones A patient was more likely to have documentation if the note was written by an intern (, Sexual and menstrual history documentation. Parents and adolescents were highly accepting of sexual health discussion, STD testing, and pregnancy testing in the acute care setting. FUNDING: Dr Kaiser is supported by grants from the Agency for Healthcare Research and Quality (K08HS024592 and R03HS027041). The Sexual Health Screen reported on by Goyal et al35 presents a feasible and valid way to screen for sexual and reproductive health. 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 Further study of technology-based behavioral interventions is warranted. However, none of the patients screened positive for SI on the SIQ (comparison standard). 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%. The Vanderbilt rating scale assesses symptoms of attention deficit disorder as well as oppositional and anxious behaviors. As physicians, we need to ask about the context of a teen's life, and the HEADSS assessment is a good guide. 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. 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.) This demonstrates that we do not viewyouth only in the risk context. In the full-text screen, both reviewers included 43 studies and excluded 25 studies; 7 studies were in conflict. Barriers identified included time, concern about follow-up, and lack of knowledge. Abstract. Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established. 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. The American Academy of Pediatrics (AAP) and other organizations recommend using this assessment in order to address risk behaviors. 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. A significant percentage of sexually active adolescents surveyed were potential candidates for EC. Teenagers report wanting to receive pregnancy and STI preventive care in the ED, regardless of the reason to visit. 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). 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] IMPACT Program | Children's Hospital Los Angeles The AAP, which said. 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. Address correspondence to Nora Pfaff, MD, Department of Pediatrics, University of California, San Francisco Benioff Childrens Hospital, 550 16th St, 5th Floor, San Francisco, CA 94143. *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 Scoping reviews map out broad themes and identify knowledge gaps when the published works of focus use a wide variety of study designs.15 We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to inform our search and synthesis of the literature.16. A screening tool is a standardized set of questions used to identify issues in a child that require further investigation. It is important to conduct adolescent substance use screening in the ED. If your child is alert and responds to you, the head injury is mild and usually no tests or X-rays are needed. HEADSSS Assessment - TeachMePaediatrics - Home - Education One study that met inclusion criteria was found post hoc and included in the final review for a total of 46 studies (Fig 1). 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. Sexual activity (patient and clinician attitudes), Computerized survey to assess acceptability and usefulness of a sexual health CDS system. Sexual history documentation was incomplete in charts of adolescents discharged from the ED with STI diagnosis. l+PxF.wYh|:7#jvUF\A_Xr9Gs#C:Ynu,-,-AFk[,b5+"*,gbJW*;A[PA[r}Xq~jy!.N(7kF f A sexual health CDS system for adolescents in the ED received high acceptability and usability ratings from ED clinicians and adolescents. 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 . Pediatrics. The Newton Screen had better sensitivity for cannabis use and good specificity for both. 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. Twenty-five percent never conducted SBIRT (limited time and resources are barriers). This study was determined exempt by the Institutional Review Board at the University of California, San Francisco. 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. Of respondents, 76.5% preferred an electronic survey to face-to-face interviews. In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (10%) but significant increases with clinician reminder implementation. 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 In their study, Erickson et al62 described screening and intervention regarding abuse or violence, specifically focusing on evaluating risk of intimate partner violence with an 8-item screening tool (the Conflict Tactics Survey). Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? Further study is warranted. The American Academy of Pediatrics recommends that clinicians screen adolescents for substance use and, if applicable, provide a brief intervention, establish follow-up, and consider referral. Moderate to good test-retest reliability was found between questionnaire takers. If a patient screens positive, MI can be used to assess readiness to change and develop patient-driven brief interventions. 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. The majority of ED physicians felt that the ED was an appropriate venue for screening and intervention on alcohol use disorders. Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. The RSQ, a verbal 4-question suicide screening instrument, Twenty-two percent of patients screened positive on the RSQ. More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. 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 ED visit may provide an opportunity to meet the contraceptive needs of adolescents, particularly for those who do not receive regular well care. 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. 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. Computerized survey to assess sexual history and interest in interventions in the ED. 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. For COVID related questions, please emailcovid-19@aap.org.For Mental Health related questions, please emailmentalhealth@aap.org.Brought to you by AAP Education. 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. RCT, randomized controlled trial; , not present; +, present. Most adolescents and parents rated screening for suicide risk and other mental health problems in the ED as important. 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. The FRAMES acronym tool can be used to outline brief interventions. Survey of 17 candidate suicide screening questions. Reported barriers were time constraints and limited resources. 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).
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