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 12-19 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 10 minute survey covering domains of depression, suicidality, trauma, firearm access, and substance abuse. Standard confidentiality practices are followed based on results. After reviewing the results the clinical team can have a discussion with the patient and may consult with representatives from ED Social Work and/or Psychiatry to assess safety risks and offer resources as needed.
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 600 behavioral health screens are completed each month in the Philadelphia and King of Prussia EDs, 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.
- Follow-Up After ED Visits for Teens with Depression and Suicidality: A Retrospective Cohort Study
Timely follow-up after emergency department (ED) visits for adolescent depression or suicidality is critical yet frequently delayed. Because many adolescents face long waits to see a psychiatrist—averaging 43 to 50 days—primary care serves as an essential safety net for timely follow-up. Despite National Committee for Quality Assurance (NCQA) quality measures recommending follow-up within 7 and 30 days after a mental health–related ED visit, fewer than two-thirds of children receive care within 30 days. In this retrospective cohort study of 3,362 adolescents aged 12–19 years across a 32-clinic primary care network, only 21.2% completed a primary care visit within 30 days and 11.1% within 7 days of an ED visit after screening positive for depression or suicidal ideation on the Behavioral Health Screen–ED. These findings reveal substantial gaps in follow-up care, with disparities by insurance, race, and neighborhood opportunity, underscoring the need for targeted care coordination and equity-focused policy interventions.
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.
