headss assessment american academy of pediatrics

Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. 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). Concussions: What Parents Need to Know - HealthyChildren.org 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. Most female adolescents with sexual experience reported interest in same-day initiation of hormonal contraception in the ED. All rights reserved. Tools to aid. Patient-administered 22- to 27-item survey on attitudes toward inpatient reproductive health screening and interventions. 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 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. 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. Four screening questions identified 99% of patients who had experienced IPV. Data sources included PubMed (19652019) and Embase (19472019). 28 Apr 2023 20:21:28 In fact, in a study by Miller et al,39 parents were more accepting of sexual activity screening and STI testing than surveyed clinicians. Adolescents reported high rates of risky behaviors and interest in receiving interventions for these behaviors. 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 . 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.) Immediate intervention in the ED and receiving information for follow-up care were rated as the most helpful responses to a positive screening result. In 75% of cases in which risk behaviors were identified, interventions were provided. Completely updated and revised for new diagnostic criteria, this toolkit provides practical guidance and fillable forms to help you turn your practice into a medical home for children with ADHD. 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. It's caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth inside the skull. 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 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. 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 2 reviewers made joint final decisions on inclusion of studies with conflicting initial determinations. Clinicians were comparatively less accepting, particularly if the visit was not related to sexual health. The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. HEADS UP to Health Care Providers: Tools for Providers Pediatrics. Within each category, we grouped studies by subcategory: screening rates, screening and intervention tools, and attitudes toward screening and intervention. Two independent reviewers screened, extracted, and summarized the studies (N.P. The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. Learn Steps to Improve the Care of Your Pediatric Patients with mTBI. The HEADSS stamp resulted in a significant increase in postintervention screening rates (from <1% to 9%; P = .003).21 The EHR distress response survey by Nager et al22 was found to be feasible to integrate into the busy ED physician workflow, but the study offered limited insight into effects on screening or utility of the tool (assessed by using only yes or no questions). The developmental milestones are listed by month or year first because well-child visits are organized this way. Almost all adolescents agreed that nurses should screen for suicide risk in the ED. To overcome these collective barriers, future researchers should investigate (1) feasible, efficient risk behavior screening tools with guidance for clinicians on providing risk behavior interventions and (2) tools that increase privacy and comfort for patients (likely through the use of electronic formats). 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. 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]). 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). A systematic review. 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. MI and brief intervention are effective methods to address high-risk behaviors. Comprehensive Adolescent Risk Behavior Screening Studies. This fast movement can cause the brain to bounce around or twist in the skull, creating . *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 In the Supplemental Information, we outline the details of our search strategy. All children should wear masks in school this fall, even if vaccinated Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. Promising methods to increase screening rates include self-disclosure electronic screening tools coupled with reminders for clinicians (paper or within the EHR). Research on clinical preventive services for adolescents and young adults: where are we and where do we need to go? Of those, 47% endorsed sexual activity. Marc Olivier: Heads up on Twitter: "RT @nancydoylebrown: David HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth, Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review, The role of motivational interviewing in children and adolescents in pediatric care. Investigates different SI screening tools used in ED. 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. 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. The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Eighty-two percent of patients who screened positively were referred to outpatient mental health, and 10% were admitted to a psychiatric facility. This IMPACT project analyzes which factors are associated with HEADSS assessment completion and aims . 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. 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. Audit of sexual activity and risk-level status documentation. Examples of secondary screening tools are, Mental Health Tools for PediatricsScreening TimeStandardized Screening/Testing Coding Fact Sheet for Primary Care Pediatricians: Developmental/Emotional/Behavioral, Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and ScreeningPromoting Optimal Development: Screening for Behavioral and Emotional ProblemsRecommendations for Preventive Pediatric Health CareSubstance Use Screening, Brief Intervention, and Referral to Treatment(Policy Statement), Addressing Mental Health Concerns in Primary Care: A Clinicians Toolkit American Academy of PediatricsLinks to Commonly Used Screening Instruments and ToolsAAP Mental Health websiteBright Futures, American Academy of Child and Adolescent Psychiatry. 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. More research and development into risk screening algorithms and interventions is needed, specifically prospective controlled trials. The APPD Longitudinal Educational Assessment Research Network's First 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. endstream endobj 323 0 obj <>stream 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). Survey to assess sexual history, sexual health knowledge, and desire for sexual health education. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). 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. Previous studies indicate low rates of risk behavior screening and interventions in ED and hospital settings. 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). The Generalized Anxiety Disorder (GAD-7) and the Screen for Child Anxiety Related Disorders (SCARED) helps the practitioner assess for an anxiety disorder. Download ACE Care Plan - Work version ACE Care Plan - School version Almost all patients deemed to have elevated suicide risk endorsed SI (SIQ-JR) and/or had a recent suicide attempt. 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. Youth presenting to the ED are at elevated risk of ARA (with reported prevalence of up to 55%). 321 0 obj <>stream Focus groups to assess clinician-perceived barriers to alcohol use screening and/or brief intervention for adolescents in the ED. Welcome to HEADS-ED. Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. By continuing to use our website, you are agreeing to, https://www.cdc.gov/healthyyouth/data/yrbs/index.htm, www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/adolescent-sexual-health/Pages/Assessing-the-Adolescent-Patient.aspx, www.pediatrics.org/cgi/content/full/123/4/e565, www.pediatrics.org/cgi/content/full/122/5/e1113, https://doi.org/10.1097/PEC.0000000000001746, www.pediatrics.org/cgi/content/full/128/1/e180, HEADSS assessmentbased interview conducted by resident physicians, HEADSS-based psychosocial screening by admitting physician, HEADSS stamp placed on patient charts to serve as a visual reminder for ED clinicians to complete psychosocial screening, The HEADSS assessment rate increased from <1% to 9% (, Tablet-based survey to assess risk behaviors, technology use, and desired format for risk behavior interventions, For each category of risk behavior assessed, 73%94% of adolescents (, Youth and Young Adult Health and Safety Needs Survey completed by HPAs. 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. 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. 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. These funders played no role in the study design, analysis, or preparation of this article. Your child's doctor will want to know when and how the injury happened and how your child is feeling. Female adolescents showed preference for in-person counseling, from a person of authority (doctor, nurse) rather than from a peer counselor. A significant proportion of adolescents were interested in starting contraception in the ED. 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. The assessment starts with simple and easy questions about life to allow a . Study design and risk of bias are presented in Table 1. Feasibility of screening patients with nonpsychiatric complaints for suicide risk in a pediatric emergency department: a good time to talk? 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). 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. Adolescents prefer in-person counseling and target education (related to their chief complaint). ED physicians used SBIRT in limited and nonstandardized ways. Dr Ozer is supported by grants from the Health Resources and Services Administration of the US Department of Health and Human Services and the Maternal and Child Health Bureau under cooperative agreement UA6MC27378 and Maternal and Child Health Bureau Leadership Education in Adolescent Health Training grant T71MC00003. In the intervention arm, the results of the screen provided decision support for ED physicians. 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. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. For anything more than a light bump on the head, you should call your child's doctor. Reported barriers were time constraints and limited resources. 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). We also excluded any studies with interventions taking place outside the urgent care, ED, or hospital because we aimed to identify interventions that could be completed during acute care encounters. The authors noted that although 94% of patients in the study were documented as sexually active, only 48% of charts documented condom use, only 38% of charts documented STI history, and only 19% of charts documented the number of partners. 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. The Academic Pediatric Association (APA) and the American Academy of Pediatrics (AAP) recently authorized task forces to address child poverty.8As a work-group of the APA Childhood Poverty Task Force Health Care Delivery Committee, we provide an evidence-based, practical approach to those aspects of surveillance and screening that apply Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent? Copyright 2023 American Academy of Pediatrics. 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. 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. 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. A sexual health CDS system for adolescents in the ED received high acceptability and usability ratings from ED clinicians and adolescents. Our data sources included PubMed (19652019) and Embase (19472019). Screening Tools: Pediatric Mental Health Minute Series, Standardized Screening/Testing Coding Fact Sheet for Primary Care Pediatricians: Developmental/Emotional/Behavioral, Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening, Promoting Optimal Development: Screening for Behavioral and Emotional Problems, Recommendations for Preventive Pediatric Health Care, Substance Use Screening, Brief Intervention, and Referral to Treatment, Addressing Mental Health Concerns in Primary Care: A Clinicians Toolkit American Academy of Pediatrics, Links to Commonly Used Screening Instruments and Tools, Long-term Follow-up Care for Childhood, Adolescent and Young Adult Cancer Survivors, Roadmap for Care of Cancer Survivors: Joint Report Updates Recommendations, American Academy of Pediatrics Offers Guidance for Caring and Treatment of Long-Term Cancer Survivors, Childhood Cancer Survivors: What to Expect After Treatment, Transition Plan: Advancing Child Health in the Biden-Harris Administration, Childrens Health Care Coverage Fact Sheets, Prep- Pediatric Review and Education Programs.

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