Emergency Department Screening for Adolescent Mental Health Disorders: The Who, What, When, Where, Why, and How It Could and Should Be Done
Section snippets
Mental Health Problems Are Perfectly Suited to Screening
In 1968, the World Health Organization published guiding principles for which medical conditions ought to be screened and how such screening should be implemented. These guidelines are summarized in Table 1 and are still very much applicable today. Screening should identify people with unrecognized, significant medical conditions, resulting in earlier diagnosis and treatment, decreasing morbidity and mortality due to the disease, and ultimately culminating in a decrease in disease burden in
Barriers to Screening
Pediatric, emergency care, and governmental organizations have advocated for ED mental health screening, including the American Academy of Pediatrics, the American College of Emergency Physicians, the National Association of EMS Physicians, the Emergency Medical Services for Children program (Health Resources and Services Administration, Maternal and Child Health Bureau), and the US Preventative Services Task Force.38, 39, 40, 41, 42 However, screening for mental health problems is not without
Is Mental Health Screening in the ED Feasible and Acceptable?
Numerous studies have shown that ED mental health screening can rapidly, efficiently, and accurately identify patients with occult mental health problems (Table 2). As few as 2 depression screening questions have been found to be helpful in both adult and pediatric ED settings. Haughey et al50 demonstrated that their 2-question screening tool resulted in a 3-fold increase in physician recognition of depression in adults. Similarly, Rutman et al23 determined that a 2-question depression screen,
Brief Pediatric ED Mental Health Screening Tools
Many efficient and practical screening tools for mental health conditions have been developed and/or tested in the ED setting. Although many remain to be fully validated in general PED populations, they have the potential to be efficient, effective screening tools. One example is the Mini-International Neuropsychiatric Interview, a brief structured, diagnostic interview, which has been previously validated in inpatient, outpatient primary care, and research clinic settings. It is designed to be
Computerized Mental Health Screening in the ED
Computerized screening may be an efficient and advantageous method for ED mental health screening, in that electronic screens require little ED clinician time or effort to administer. They have successfully been used in both pediatric and general ED settings for alcohol/substance use, alcohol and youth violence, injury prevention, general health and mental health screening, and HIV risk behaviors. Choo et al60 performed a systematic review of technology-based behavioral health screening and
Summary
Mental health problems in children and adolescents are very common, unfortunately with very high morbidity and mortality, both in the near and long term. Screening for such problems will result in earlier identification of these patients and may increase treatment of these problems and ultimately result in secondary and tertiary prevention of the sequelae of pediatric mental health disorders. Populations who visit EDs are known to be at high risk for occult mental health disorders. The ED visit
Acknowledgments
Grant Support: Supported in part by “Teaching an Alcohol Intervention to Pediatric ER Staff,” National Institute for Alcohol Abuse and Alcoholism, K23 AA014934 (THC); and “ED Based Prevention Intervention to Delay Alcohol Use by Young Adolescents,” National Institute of Alcohol Abuse and Alcoholism, R21 AA018380 (JGL). “Teen Alcohol Screening in the Pediatric Emergency Care Applied Research Network," National Institute of Alcohol Abuse and Alcoholism, R01 AA021900 (JGL and THC).
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Cited by (30)
Utility of MyHEARTSMAP for Universal Psychosocial Screening in the Emergency Department
2020, Journal of PediatricsAcceptability of Adolescent Social and Behavioral Health Screening in the Emergency Department
2019, Journal of Adolescent HealthCitation Excerpt :Although a majority of male and female adolescents agreed that screening should be conducted across most domains, we found that adolescent females were more likely than males to find SBHR screening acceptable in a number of sensitive domains, such as depression, suicidality, and sexual activity. This corroborates the findings of prior work on the subject, which also found female youth more accepting of ED-based screening than their male counterparts [18]. In addition, our data indicate that caregivers are more accepting of screening than patients across most domains, with the exceptions of housing instability, suicidality, and sexual activity.
Visits to an emergency department by children and adolescents with substance-related disorders and the perceptions of nursing professionals
2018, Children and Youth Services ReviewCitation Excerpt :It is also expected that these teams manage the inherent difficulties regarding substance-related disorders that are an expressive cause of visits in these settings (Conlon & O'Tuathail, 2012; Nicholls, Gaynor, Shafiei, Bosanac, & Farrell, 2011). Previous studies about children and adolescents and emergency assistance have investigated how the characteristics of medical teams in EDs influence decisions about the management of these patients (Muroff et al., 2008), the effects of assistance to them (Sheridan et al., 2016), the sociodemographic and clinical profiles of pediatric and adolescents that visited emergence departments (Chun et al., 2013; Costa et al., 2012; Dolan & Fein, 2011), and parameters for the treatment of psychiatric or substance-related disorders (Bukstein, 2005; Dolan & Fein, 2011; WHO, 2008). Nevertheless, studies about the actions, skills, and attitudes of nursing teams to emergency assistance for patients with psychiatric disorders (Elias, Tavares, & Cortez, 2013; Manton et al., 2013; Nicholls et al., 2011; Shafiei, Gaynor, & Farrell, 2011) or with substance-related disorders (Kelleher & Cotter, 2009) have focused mostly on the adult population.
Problem Behaviors and Psychological Distress Among Teens Seen in a National Sample of Emergency Departments
2018, Academic PediatricsCitation Excerpt :Barriers to implementation must be considered, including the lack of high-quality short screening measures for adolescent mental health, violence, and substance use in the ED; lack of ED practitioner time; lack of community resources once an issue is identified; and concerns about stigma.25,26 Some literature has described universal ED-based adolescent mental health screening,3,24 and the value of interventions for adolescent mental health, violence, and substance use issues identified by targeted screening.14,27 Future studies should address the feasibility and utility of such targeted screening and interventions, and should elucidate which issue (the problem behavior, or the psychological distress) is most easily or effectively ameliorated.
Current Pediatric Emergency Department Innovative Programs to Improve the Care of Psychiatric Patients
2018, Child and Adolescent Psychiatric Clinics of North AmericaCitation Excerpt :The Centers for Disease Control and Prevention recognized the significance of mental health (MH) disorders among children and estimate that 22% of children have or have had a serious mental health disorder.1–3 Although the numbers of children and adolescents with MH conditions continue to increase, only 36% receive MH services and only 40% with severe impairment receive care.4 MH treatment of the pediatric population is often fragmented and difficult to access because of insufficient outpatient and inpatient treatment options.5,6
PTSD, cyberbullying and peer violence: Prevalence and correlates among adolescent emergency department patients
2016, General Hospital PsychiatryCitation Excerpt :Such screening would facilitate both alterations in the immediate care provision, for instance, by using a trauma-informed care protocol [40], and in the long-term plans for affected individuals, by facilitating referral to a collaborative or psychiatric care program [41]. Some studies suggest that the emergency department (ED) may be an appropriate location to screen adolescents for PTSD and other psychiatric disorders [42,43], given the large number of high-risk adolescents seen in the ED and the important role of the ED as a liaison to community mental health services [44]. Emergency physicians, however, are currently limited in their understanding of the prevalence and impact of PTSD in adolescent ED patients [45], particularly among patients who are not necessarily presenting in the aftermath of an obviously traumatic event.