Improving Adolescent Primary Care Through An Interactive Behavioral Health Module

Most adolescents visit a health care provider once a year, presenting an opportunity to integrate behavioral and emotional health screening into clinical care. Yet despite clinical guidelines, providers’ rates of screening adolescents for risky health behaviors and depression are lower than recommended. Therefore, new strategies are needed to increase behavioral health screening in primary care. Clinical decision support (CDS) has tremendous potential to improve behavioral health care for adolescents.

This exploratory project developed an interactive behavioral and emotional health module that was integrated into adolescent health care delivery. The module, Health e-Check, included a risk assessment for adolescents and a CDS intervention tool for providers. The module was piloted and assessed in adolescent primary care practices by the San Francisco Bay Collaborative Research Network (CRN) through the University of California, San Francisco (UCSF).

The specific aims of this project were as follows:

• Develop a theoretically based interactive behavioral and emotional health module for adolescents that can be integrated into health care delivery, serving as both a risk assessment and an intervention tool to enhance adolescent behavior change.
• Pilot-test the implementation of the computerized module and screening system in adolescent primary care, assessing clinician, adolescent, and system outcomes.

The study was conducted in two phases. In the first phase, the research team developed Health e-Check, a tablet screening module covering multiple behavioral risk areas and emotional health, able to be completed by adolescents in 5 minutes. The responses were integrated into the electronic medical record and used to generate a customized printout for providers. The printout included information about the adolescent’s behaviors and speaking prompts for providers to use when discussing health behaviors with teens.

In the second phase, the module was implemented in two primary care clinics serving diverse populations of adolescents. Qualitative and quantitative methods were used to assess the acceptability of the intervention, determine whether the intervention increased provider rates of screening and counseling, and assess the effects of the intervention on adolescent behavioral health. The results indicated that the module was acceptable to adolescents and providers. Provider rates of behavioral health screening and counselling increased. Adolescents reported being more comfortable and honest when completing the screening by computer than with a provider. The research team concluded that Health e-Check has the potential to improve behavioral health screening for adolescents and future research should focus on adaptation of the module for integration across diverse health delivery systems.