Starting in January of this year, we have implemented a confidential and comprehensive adolescent health screen for teens and young adults 14 and up in our office called the "Behavioral Health Works". The screen was piloted at the renowned Children's Hospital in Philadelphia and now is utilized in their ER and in over 50 primary care offices.
The questionnaire covers 10 key domains: school, family, substance abuse, safety, demographics, medical, nutrition/eating, depression, anxiety, suicide, trauma, psychosis, and bullying. It usually takes less than 10 minutes to screen and is done on the computer. Analysis shows it is a reliable and valid tool for measuring adolescent and young adult behavioral health. It scores risk behaviors and identifies strengths so that your pediatrician can facilitate conversation and referrals to mental health professionals if needed.
Anxiety and depression are omnipresent in the pediatric population. As of 2015, The National Institute of Mental Health found that 6.3 million teens of 30% girls and 20% boys have had an anxiety disorder. About 5% adolescents suffer from depression at any given time. In the US, primary care has become the #1 source of mental health care. Mental Health is difficult to quantify and can be difficult to talk about, especially when you are a teenager. We chose to implement the screen in our office to identify anxiety and depression more accurately and quickly, and to also identify teens at the greatest risk: those who contemplate suicide or have attempted suicide. In the US, suicide is the number one cause of death for teens aged 10-24. Females are four times more likely to attempt suicide but males are four times likely to die. These are sobering statistics for those of us who work with children daily.
For those contemplating suicide, it is a way to eliminate suffering or deep psychological pain/anguish. It is an interplay of behaviors, negative thoughts, and physical symptoms that leads to suicide Worrisome behaviors include: withdrawing, talking about suicide, self-harm, and addiction. Worrisome thoughts include feeling hopeless, trapped, shameful and guilty. Physical symptoms can manifest as: insomnia, agitation, restlessness, and physical pain. Risk factors include: previous suicide attempts, history of self-harm, and a history of psychiatric disorder. The best method to help those who exhibit suicidal thoughts is to plug them in immediately with skilled professionals who can talk them through their deep psychological pain and possibly recommend medication/inpatient treatment if necessary.
We never want to miss a child who needs help that walks through our office doors. We are cognizant that we may only have one shot a year to capture those teenagers who are struggling or thinking about suicide. We know mental health issues are at times difficult to talk about, and we have seen in real life how this particular screen has helped identify at risk teens and facilitate appropriate care and follow up.
We are hopeful that you as the parent will see this survey as an opportunity and not as "another thing" when you come in for your teens annual check-up. We hope you, as the adolescent, will know the information you fill out on the survey is confidential (even if that means you don't want mom or dad to know) and that you can talk about openly with your pediatrician. Together, we are optimistic that we can open the lines of communication and tackle any issues that may arise together.