Emergency Department Screening for Adolescent Mental Health Disorders: The Who, What, When, Where, Why, and How It Could and Should Be Done

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Mental health problems are a significant cause of morbidity and mortality among pediatric populations. Screening for mental health can result in earlier identification and increase treatment and improve outcomes. The emergency department (ED) is an ideal site for such screening. Pediatric ED patients are known to be at higher risk for mental health problems. For many, an ED visit is one of the few opportunities to identify and intervene with these children and adolescents. A number of brief, efficient screening instruments have been developed for the ED setting. Screening for mental health problems is both feasible and acceptable to ED patients, parents, and caregivers.

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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