Risk Behavior Screenings for Youth Infrequent in Hospital Settings

By Lisa Rapaport

April 08, 2021

(Reuters Health) - Youth risk behavior screening rates are low in hospital, emergency department, and urgent care settings, a scoping review suggests.

Researchers examined data from 46 studies that focused on risk behavior screening rates and intervention tools for assessing and treating youth aged 10 to 25 years. Most of the studies looked at emergency departments (38) and the most common behaviors examined were sexual health (19), mood and suicidal thoughts (12), substance use (7), and violence (2).

In 6 studies that looked at comprehensive risk behavior assessments, screening rates were around 10%, the authors report in Pediatrics. In cases when risk behaviors were identified, interventions were offered in about 75% of cases.

"This is a problem because adolescents often miss yearly well-visits, and so these emergency department and hospital visits may be the only opportunity to uncover and address these problems," said lead author Dr. Nora Pfaff, an assistant professor of pediatrics at the Benioff Children's Hospital at the University of California San Francisco.

"Also, these behaviors can sometimes be the cause of the ED or hospital visit and screening can lead to accurate diagnosis and treatment," Dr. Pfaff said by email.

One study that looked at adolescents' views found that 73% to 94% would be open to interventions, the review also found.

Screening rates for sexual activity were low in both the hospital and emergency department settings, ranging from 55% to 62%. Even when patients had a documented sexual or reproductive history, screening for behaviors like condom use, birth control use, and number of partners was rare.

Within hospitals, barriers to sexual activity screenings included lack of knowledge about contraception, concerns about how to follow-up with patients after discharge, and time constraints.

None of the studies included in the analysis focused on screening rates for mood and suicidal ideation. One study of urgent care patients found teens that did screen positive for suicidal ideation did not have mental health-related chief complaints.

Studies that focused on substance misuse found that most youth and parents valued the opportunity for immediate interventions when youth screened positive.

One limitation of the study is the heterogeneity of the quality and design of the smaller studies included, which precluded meta-analysis, the researchers note. In addition, the exclusion of studies involving outpatient follow-up may have limited the ability to determine any long-term effects of screenings or interventions in the hospital setting.

"There are multiple potential reasons why adolescent risk behavior screening in the hospital and ED settings is low - likely, constraints on time, addressing other urgent issues, and lack of provider comfort or understanding of next intervention steps following screening for those individuals who do report risky behaviors are all contributing factors," said Dr. Devika Bhatia, a child and adolescent psychiatry fellow at the University of Colorado School of Medicine in Aurora.

"If adolescents are not receiving comprehensive evaluations, it can be difficult for them to receive the care they may need," Dr. Bhatia, who wasn't involved in the study, said by email.

Clinicians should begin to champion such screening, said Dr. Federico Vaca, of the department of emergency medicine and the Child Study Center at Yale School of Medicine in New Haven, Connecticut. And, healthcare systems need to invest in this, Dr. Vaca, who wasn't involved in the study, said by email.

"Comparatively, it's a relatively small ask for improving the health of youth," Dr. Vaca said. "There is considerable return on investment in identification and prevention in this context."

SOURCE: https://bit.ly/3cVFixU Pediatrics, online March 30, 2021.

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