Op-Med is a collection of original articles contributed by Doximity members.
The thought of discussing serious topics, like mental health, substance use, or sex with pediatric patients can send shivers down your spine. If you agree, don’t worry, you’re not alone! Comprehensive risk screening can feel overwhelming, even scary. But now that Halloween is behind us, it’s time to shake it off — what fears are getting in the way?
Fear of shouldering the responsibility to take action (and not having the resources to address identified risks). Risk screening opens the door for youth to connect with you as a trusted adult. Making this connection provides an opportunity for youth to let an adult know what they are struggling with, to receive information, resources, and, when necessary, referrals to other professionals. Here are just a few reasons why making these connections is so important:
- Nearly half of all youth who commit suicide visited a health care provider during the month prior to their suicide.
- Mental health risks are often higher than the risks presented by drug, alcohol and tobacco use among youth.
Fear of not having enough time. There never seems to be enough time in the day. Finding practical solutions that minimize the impact on time and workflow might feel unrealistic, but with a standardized screening tool, it is possible. Even in the tightest of workflows, in organizations that already run like clockwork, finding a 5-minute window of time for risk screening (while youth are waiting for you to come into the exam room, for example) could save a life!
Fear of upsetting parents. We get it, parents may be uncomfortable with the idea of their teen being asked about risk factors and behaviors. You can help parents understand the importance by explaining that standardized risk screening is an opportunity to stop an uptick in bullying, prevent a potential suicide, or identify substance use.
Fear of not knowing what to say. Conversations about risk can be uncomfortable. But did you know that having a trusted adult to confide in is one of the single most important mitigating factors in reducing youth risk? Just by being present and starting the conversation, you are helping. If you want to take your youth communication even further, Adolescent-Focused Motivational Interviewing workshops can help.
Fear that asking the “tough” questions will re-traumatize or cause additional harm. In reality, asking tough questions provides the opportunity for youth to share their experiences, which has shown to be the impetus for getting help. In a study examining the potential harm associated with suicide risk screening among high school students, res researchers found no evidence of negative effects. Another study on trauma and sex showed that the majority of participants, including women with a history of sexual victimization, reported that they did not experience distress during screening. In fact, participants with a history of sexual victimization rated the study as producing in themselves a higher positive affect (comparative to control participants). The participants also rated the mental cost of participating as low.
Youth must have an opportunity to talk about what they have witnessed and how they feel in an emotionally safe space. The willingness of health care professionals to listen to a child’s story can provide the foundation on which to increase resilience and personal strength.
Remember, not asking is not preventing. Youth risk screening with a standardized, validated screening tool is recommended by every leading health care organization. And, just as there is evidence of the need for screening and risk reduction efforts, there is significant evidence for what makes a risk screening effective. The CDC supported the development of an evidence-informed framework for risk screening in an effort to provide guidance to CMS, to health care providers, and to other professionals wishing to implement a risk screening process.
The CDC framework recommends screenings be tailored for literacy, culture, and/or age groups, and should be evaluated for validity and reliability.
Navigating conversations around risk topics may be uncomfortable, regardless of expertise or experience, but having the conversation is absolutely worth it.
Jennifer Salerno, DNP, FAAANP is a pediatric nurse practitioner and advocate for adolescent risk prevention. Jennifer founded Possibilities for Change, the distributor of the RAAPS tools, and has worked in partnership with clinicians, researchers, and youth to develop technology-based adolescent risk screening and counseling tools, which are now being used by health professionals worldwide.