Improvement in Adolescent Screening and Counseling Rates for Risk Behaviors and Developmental Tasks

BACKGROUND: High-quality preventive services for youth aged 11 to 18 include assessment and counseling regarding health behavior risks and developmental tasks/strengths of adolescence. Nationally, primary care health behavior risk screening and counseling rates lag consid-erably behind other preventive health services. The purpose of this project was to assist pediatric and family medicine practices to make office systems–based changes that promote comprehensive screening and counseling for risks and developmental tasks/strengths during adolescent preventive services visits. METHODS: Over a 9-month period, 7 pediatric and 1 family medicine primary care practices (13 physicians and 3 nurse practitioners) participated in a modified Breakthrough Series Collaborative. This project was designed to support primary care practitioner efforts to implement comprehensive screening and counseling for risk behaviors and developmental tasks/strengths for their adolescent patients and increase the rate of brief office intervention and referral. Composite variables were designed to reflect whether screening and counseling were documented for risks and developmental tasks. Statistical comparisons were made by using the nonparametric Wilcoxon matched-pairs signed rank test. RESULTS: There were increases in the composite measures of screening and counseling for risk behaviors (all 6 risks: 26%–50%, P = .01) and 3 of 4 developmental tasks/strengths (32%–66%, P = .01). Documentation of office interventions for identified risks and out-of office referral rates did not change. CONCLUSIONS: With the use of an office systems–based approach, screening and counseling for all critical risk behaviors and developmental tasks/strengths during adolescent preventive services visits can be improved in primary care practices. * Abbreviations: BTS — : Breakthrough Series CRAFFT — : Car-Relax-Alone-Forget-Friends-Trouble EMR — : electronic medical record HEEADSSS — : Home environment, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide, and Safety PCP — : primary care practitioner