Behavioral Health Screen
Although adolescent mental health needs are prevalent, it is not always simple for healthcare providers to identify those concerns and connect youth and families to appropriate resources. To aid early identification of mental health needs, since 2007 an electronic, self-administered behavioral health screen has been part of the standard of care at CHOP’s Emergency Department (ED). All CHOP ED patients ages 14-19 are offered the behavioral health screen, regardless of the health concern that brought them there.
The Behavioral Health Screen for the Emergency Department (BHS-ED), developed in partnership with MDLogix and Drexel University, is a 7-10 minute survey composed of 50 questions, covering domains of depression, suicidal ideation, trauma, firearm access, and substance abuse. The results are confidential and are not shared with parents or caregivers. After seeing the results the clinical team can have a discussion with the patient and may offer resources as needed. In addition, if there is concern for abuse, current suicidality or severe depression the clinical team will consult with representatives from Social Work and/or Psychiatry.
The ED provider also communicates important findings from the screening to the patient’s primary care provider (PCP), who is best positioned to follow up on the most appropriate next steps. CHOP research published in Pediatric Emergency Care showed that a multifaceted intervention including education and an electronic health record alert improved ED documentation, communication, and PCP follow-up of issues identified during the ED-based behavioral health screen.
Currently, more than 300 behavioral health screens are completed each month in the CHOP ED, with approximately one-third of screenings revealing symptoms of moderate to severe depression or suicidal ideation. Importantly, many patients who screen positive did not initially come into the ED with a mental health complaint. Oftentimes, they report non-specific symptoms such as headache, chest pain, and abdominal pain.
De-identified data from the BHS are managed by ARCUS – an integrated data science platform unique to CHOP– and are being analyzed for studies in partnership with the CHOP and Penn Departments of Psychiatry and Safe Place.
Completed Research
- Neighborhood Firearm Violence, Psychosocial Risks, and Youth Firearm Perception
In collaboration with the University of Pennsylvania School of Nursing, CVP researchers examined 23,334 emergency department visits between 2013 and 2024 by teenagers aged 14-18 who underwent behavioral health screening. Findings document a substantial link between exposure to neighborhood firearm violence, participation in fighting, and an adolescent's perceived ability to acquire a firearm outside their homes. This study illustrates that emergency departments can gather information that can lead to crucial intervention points for firearm injury in youth. The authors recommend that EDs universally screen not only for firearm possession but also for perceived firearm access and past fighting behavior.
Recommended Resources
- Learn More
- Diamond G, Levy S, Bevans KB, et al. (2010). Development, Validation, and Utility of Internet-based, Behavioral Health Screen for Adolescents. Pediatrics, 126, e163–e170.
- Esposito J, Fein JA, Marshall J, Mitchell C, Aredas B, Zorc JJ (2020). Improving Mental Health Communication From the Pediatric Emergency Department to Primary Care. Pediatric Emergency Care, 36(9):424-9.
- Fein JA, Pailler ME, Barg FK, et al. (2010). Feasibility and Effects of a Web-based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency Department. Archives of Pediatrics and Adolescent Medicine, 164, 1112–1117.
