Patient and Caregiver Attitudes Towards Comprehensive Behavioral Health Screening in the Emergency Department

Purpose: The American Academy of Pediatrics recommends routine screening for behavioral and mental health risk (BHS) in adolescents. Because adolescents who seek care in emergency departments (EDs) may have riskier behaviors than adolescents who access primary care, the ED may be a strategic setting for screening. The objective of this study was to assess patient and caregiver acceptance of a comprehensive behavioral health screen in the pediatric ED. Methods: A cross-sectional study of 14- to 21-year old patients and their caregivers who presented to an urban pediatric ED. Participants completed a computer-assisted questionnaire to assess acceptance of ED-based screening for the following domains of behavioral health: depression, suicidality, access to firearms, substance use, sexual activity, violence, human trafficking, and housing instability. We calculated screening acceptability for each domain and performed multivariable logistic regression to assess differences in acceptance between adolescents and caregivers. Results: The 516 study participants (347 adolescents and 169 caregivers) reported the following rates of screening acceptance: depression 70.0%; suicidality 78.1%; firearm access 50.4%; substance use 76.9%; sexual activity 73.8%; violence 71.9%; human trafficking 59.3%; housing insecurity 65.1%. After adjustment for race/ ethnicity, gender, and insurance status, patients were less likely than caregivers to support screening for depression (66.9% vs 76.3%; aOR 0.6 [0.4, 1.0] ), firearm access(45.0% vs. 61.5%; aOR 0.5 [0.3, 0.7], substance use (73.5% vs 84.0%; aOR 0.5 [0.3,0.8]), violence (69.2% vs 77.5%; aOR 0.6 [0.4, 1.0]) and human trafficking (55.3% vs 67.5%; aOR 0.6 [0.4,0.9]). Almost all caregivers would allow their children to participate in confidential screening (91.6%), allow physicians to speak privately with their children following screening (82.6%), extend their ED stay to speak with social work (77.3%) and follow up with resources provided (89.8%). Conclusions: Comprehensive behavioral health screening in the ED is acceptable to both adolescents and caregivers. Acceptability of screening varies across domain areas, but the majority of adolescents and caregivers are in favor of screening in all areas. Across most domains, caregivers have higher rates of screening acceptance than adolescent patients