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Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review

  • Jérémy Glasner
    Correspondence
    Address correspondence to: Jérémy Glasner, M.D., Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Avenue de la Sallaz 2, Lausanne 1011, Switzerland.
    Affiliations
    Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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  • Valentina Baltag
    Affiliations
    Department of Maternal, Newborn, Child, Adolescent Health and Ageing (MCA), World Health Organization (WHO), Geneva, Switzerland
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  • Anne-Emmanuelle Ambresin
    Affiliations
    Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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Open AccessPublished:November 18, 2020DOI:https://doi.org/10.1016/j.jadohealth.2020.10.003

      Abstract

      Adolescence and young adulthood constitute a period when exploratory behaviors can evolve into risky behaviors. Most causes of adolescent ill health are preventable; therefore, it is a priority to detect them early before they turn into health problems. Previsit multidomain psychosocial screening tools are used by professionals to detect and prioritize potentially problematic issues. In conjunction with appropriate clinician training, these tools have improved clinician screening rates in several areas of adolescent health. This article reviews existing multidomain previsit psychosocial screening tools developed in the 21st century and describes their characteristics using a systematic methodology.
      We reviewed 10,623 records to identify 15 different tools in use since 2000 and described their characteristics. Results show that all tools were developed in high-income countries. The tools provide sufficient coverage of many psychosocial domains relevant to young people's health. However, some psychosocial domains such as screen use and strengths are seldomly addressed. Furthermore, the tools rarely focus on young adults as a target population. Future research should assess the effectiveness, acceptability, and psychometric properties of validated psychosocial screening tools and examine how to expand their use in low- and middle-income countries.

      Keywords

      Implications and Contribution
      The findings of the current literature review call for an improvement in and validation of existing previsit screening tools. A validated universal previsit multidomain screening tool is a promising way to support professionals in reducing the burden of disease among adolescents and young adults around the world.
      See Related Editorial on p.429
      Adolescents and young adults are defined as individuals aged 10–19 and 20–24, respectively [
      World Health Organization
      Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation.
      ]. This period between childhood and adulthood is characterized by important biological, emotional, and social changes that offer great opportunities for positive development, yet are also accompanied by risk of increased vulnerability [
      • Sawyer S.M.
      • Afifi R.A.
      • Bearinger L.H.
      • et al.
      Adolescence: A foundation for future health.
      ,
      • Sawyer S.M.
      • Azzopardi P.S.
      • Wickremarathne D.
      • Patton G.C.
      The age of adolescence.
      ].
      Globally, the major causes of loss in disability adjusted life years linked to psychosocial issues in adolescents and young adults are anxiety disorders, depressive disorders, self-harm, road traffic injury, childhood behavioral disorders, drowning, and interpersonal violence. They represent almost half of all disability adjusted life years for adolescents and young adults [
      World Health Organization
      Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation.
      ,
      World Health Organization
      Global health estimates 2015: Deaths by cause, age, sex, by country and by region, 2000-2015.
      ]. In addition, almost 70% of disease burden in adults can be prevented by interventions in adolescence targeting major risk factors for noncommunicable diseases such as tobacco and alcohol use, unhealthy diet, and sedentary lifestyles [
      • Dick B.
      • Ferguson B.J.
      Health for the world's adolescents: A second chance in the second decade.
      ].
      Given the link between adolescent and adult health, it is crucial to promote a life-course perspective in adolescent health. This entails not only dealing with imminent risks and salient problems to help adolescents stay healthy in the present, but also encouraging healthy lifestyles and discouraging harmful exposures and behaviors (e.g., air pollution, violence, alcohol, and tobacco use) to reduce morbidity, disability, and premature mortality later in adulthood and future generations [
      World Health Organization
      Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation.
      ].
      Most causes of adolescent ill health are preventable; therefore, it is a priority to detect them early before they turn into health problems. The World Health Organization and many other international organizations promoting adolescent health such as the American Academy of Pediatrics and the International Association for Adolescent Health recommend facilitating young people's disclosure of their risk-taking behaviors and concerns beyond the presenting complaint, by prompting a discussion alongside the general psychosocial assessment [
      World Health Organization
      Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation.
      ]. Screening across multiple domains allows for a holistic assessment of the patient and helps professionals better understand how issues may be interconnected. Indeed, risky behaviors often evolve in clusters: when adolescents adopt a risky behavior in one domain, the probability of having issues in another domain increases [
      • Hallfors D.D.
      • Waller M.W.
      • Ford C.A.
      • et al.
      Adolescent depression and suicide risk: Association with sex and drug behavior.
      ,
      • Charrier L.
      • Berchialla P.
      • Dalmasso P.
      • et al.
      Cigarette smoking and multiple health risk behaviors: A latent class regression model to identify a profile of young adolescents.
      ,
      • Gausman J.
      • Lloyd D.
      • Kallon T.
      • et al.
      Clustered risk: An ecological understanding of sexual activity among adolescent boys and girls in two urban slums in Monrovia, Liberia.
      ,
      • Bond L.
      • Patton G.
      • Glover S.
      • et al.
      The Gatehouse project: Can a multilevel school intervention affect emotional wellbeing and health risk behaviours?.
      ].
      Taking into account the need to screen for multiple risky behaviors, the HEADSS psychosocial interview tool was developed in 1988 to help physicians detect problems earlier and more effectively. These six broad screening areas stand for Home environment, Education and employment, peer Activities, Drugs, Sexuality and Suicide/depression [
      • Goldenring J.M.
      Getting into adolescent heads.
      ]. Since then, the acronym has been broadened to include some other aspects such as Eating, Safety and security, Screens and Strengths, resulting in the acronym HEEADSSS [
      • Goldenring J.M.
      • Rosen D.S.
      Getting into adolescent heads: An essential update.
      ,
      • Klein D.A.
      • Goldenring J.M.
      • Adelman W.P.
      HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media.
      ].
      Unfortunately, little research has focused on the effectiveness of such tools or on identifying the most useful psychosocial domains for screening. Nevertheless, the existing literature shows that psychosocial risk screening together with counseling intervention has a positive impact on young people's engagement with primary care and on their health outcomes [
      • Sanci L.
      • Grabsch B.
      • Chondros P.
      • et al.
      The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice.
      ,
      • Richardson L.P.
      • Zhou C.
      • Gersh E.
      • et al.
      Effect of electronic screening with personalized feedback on adolescent health risk behaviors in a primary care setting: A randomized clinical trial.
      ,
      • Ozer E.M.
      • Adams S.H.
      • Lustig J.L.
      • et al.
      Can it be done? Implementing adolescent clinical preventive services.
      ,
      • Webb M.
      • Kauer S.
      • Ozer E.
      • et al.
      Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review.
      ].
      Many obstacles to early detection remain. In the clinical setting, some obstacles stem from insufficient training of health care providers, which is related to a general scarcity of adolescent-competent health professionals and adolescent-responsive care [
      • Tylee A.
      • Haller D.M.
      • Graham T.
      • et al.
      Youth-friendly primary-care services: How are we doing and what more needs to be done?.
      ,
      • Sawyer S.M.
      • Baltag V.
      Toward an adolescent competent workforce.
      ]. Other obstacles are environmental, such as the lack of private consultation rooms and consultation-billing practices, stymieing confidential care, which call into question the acceptability of health care by adolescents [
      • Tylee A.
      • Haller D.M.
      • Graham T.
      • et al.
      Youth-friendly primary-care services: How are we doing and what more needs to be done?.
      ]. Finally, time constraints of primary care physicians are reported as a key obstacle to the implementation of early detection screening practices and are one of the major reasons why desired discussions on health topics do not occur [
      • Strasburger V.C.
      • Brown R.T.
      • Braverman P.K.
      • et al.
      Adolescent medicine: A handbook for primary care.
      ]. Studies report a high prevalence of consultations in the emergency room for this population [
      • Weiss A.L.
      • D'Angelo L.J.
      • Rucker A.C.
      Adolescent use of the emergency department instead of the primary care provider: Who, why, and how urgent?.
      ]. Yet, time constraints are characteristic of emergency care settings, which are thus far from ideal to promote effective adolescent-friendly health care. Outside of the clinical setting, barriers to health care accessibility include insurance coverage and cost, limited knowledge of the care network on the part of adolescents, and transition failure [
      • Tylee A.
      • Haller D.M.
      • Graham T.
      • et al.
      Youth-friendly primary-care services: How are we doing and what more needs to be done?.
      ]. Generally, adolescents have less regular contact with the health system than other age groups, and they often get lost in the transition from pediatric to adult health care [
      • Nair M.
      • Baltag V.
      • Bose K.
      • et al.
      Improving the quality of health care services for adolescents, globally: A standards-driven approach.
      ,
      • Sawyer S.M.
      • Baltag V.
      Quality healthcare for adolescents.
      ].
      Barriers to health care access require creative solutions in identifying the ideal setting to foster preventive care and present opportunities for early detection. In this context, population-based preventive interventions have been shown to reduce risks and enhance protection in communities through effective outreach to young people. Indeed, risk and protective factors predictive of adolescent risk-taking behaviors exist in multiple ecological domains such as community, school, family, and peer groups. Therefore, psychosocial screening could be promising in settings other than health care, such as community settings [
      • Hawkins J.D.
      • Catalano R.F.
      • Arthur M.W.
      Promoting science-based prevention in communities.
      ]. Overcoming barriers calls for a multilevel approach including training of health care providers, improvement of health facilities, advocacy for universal coverage, and community interventions.
      Previsit screening tools—also called preconsultation or pre-encounter instruments—offer a promising start by responding to barriers such as time constraints, lack of training, and accessibility.
      Previsit tools are self-administered before the encounter with a health, education, or social service professional. They can be completed at home, school, or in the waiting room. The professional has access to the results before or right at the beginning of the consultation, and can use them as a guide to orient the consultation in light of the patient's responses.
      Among the multiple benefits of psychosocial assessment, looking for adolescent strengths and resources are fundamental to promote positive youth development and enhance resilience. It helps indicate treatment opportunities, such as untreated mental health conditions that are of high concern during adolescence. Similarly, it enables addressing issues such as sexuality together with the emerging need for contraception or protection. It identifies risky behaviors and potential need for clinical intervention [
      • Ozer E.M.
      • Adams S.H.
      • Lustig J.L.
      • et al.
      Can it be done? Implementing adolescent clinical preventive services.
      ,
      • Bradford S.
      • Rickwood D.
      Psychosocial assessments for young people: A systematic review examining acceptability, disclosure and engagement, and predictive utility.
      ].
      A comparison between a previsit multidomain tool and a clinician interview assessment showed shorter administration time, higher detection rate, and equivalent acceptability [
      • Thabrew H.
      • D'Silva S.
      • Darragh M.
      • et al.
      Comparison of YouthCHAT, an electronic composite psychosocial screener, with a clinician interview assessment for young people: Randomized controlled trial.
      ]. Previsit screening enables greater disclosure of sensitive topics as patients are given time alone to reflect on and answer questions [
      • Bradford S.
      • Rickwood D.
      Psychosocial assessments for young people: A systematic review examining acceptability, disclosure and engagement, and predictive utility.
      ]. However, questions remain about which previsit screening tools are most appropriate for widespread use. The aims of this article are to review existing multidomain previsit psychosocial screening tools developed in the 21st century and to describe their characteristics using a systematic methodology.

      Methods

      We undertook a systematic review of the literature following the Guidance for conducting systematic scoping reviews developed by the Joanna Briggs Collaboration [
      • Peters M.D.
      • Godfrey C.M.
      • Khalil H.
      • et al.
      Guidance for conducting systematic scoping reviews.
      ]. We chose this systematic process because it corresponds best to our aim of clarifying key concepts, mapping the existing literature, describing trends, and identifying research gaps [
      • Armstrong R.
      • Hall B.J.
      • Doyle J.
      • Waters
      Cochrane update. 'Scoping the scope' of a Cochrane review.
      ].
      The eligibility criteria for the tools included the target audience being the general adolescent and young adult population between 10 and 24 years old; the timing being previsit, the inclusion of at least three independent psychosocial domains; and application in a primary care, social or school context. There are no clear definitions in the literature for “multidomain” when applied to a screening tool. We decided to include tools evaluating three or more psychosocial domains to approach a global assessment. This decision is based on the observation that screening tools focusing only on one area—e.g., substance use—were in fact often associated with a second domain that could be closely connected—e.g., substance use and mental health. For the psychosocial domains, we used the acronym HEEADSSSSS. This includes the latest published version of the acronym—i.e., HEEADSSS standing for Home environment, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, and Safety from injury and violence [
      • Klein D.A.
      • Goldenring J.M.
      • Adelman W.P.
      HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media.
      ]. Two S's for Screen use and Strengths were important additions. We included sources published between January 2000 and December 2018. The search included records published in English, French, Spanish, Romanian, and Russian given the authors' language skills.
      A search strategy was developed and adapted to nine relevant databases: Embase, PubMed, CINHAL, PsychINFO, Cochrane Library, Web of Science, Global Index Medicus, SciELO, and Sociological Abstracts. Key terms combined the concepts of “adolescence”, “psychosocial screening tools”, and “previsit” (the complete search strategies can be found in Appendix A). In addition, we conducted bibliographic mining and manual searches in databases such as Google Scholar, the Campbell Collaboration, IRIS, Proquest dissertation and thesis, and the Mental Measurements Yearbook. Finally, we contacted experts through the World Health Organization network, Lausanne University Hospital's Interdisciplinary Division for Adolescent Health network and the International Association for Adolescent Health. We did not include commercial tools that were not made available by the author or were not available in the accessible literature. When instruments covered only part of the target age group (e.g., 18 years and older), they were excluded because the primary audience was not adolescents and young adults.
      The records were scanned by title and abstract, and irrelevant records were removed. At this stage, all records describing the development of a tool or mentioning the use of a tool were retained. From 10,623 records, a sample of 300 records was scanned by two authors (J.G., A.-E.A.) to ensure the consistent application of the eligibility criteria. After reaching a high level of consistency, the remaining records were screened by one author (J.G.). Any uncertain records were discussed by the same two authors (J.G., A.-E.A.). About 82 records were retained for full text screening by two authors (J.G., V.B.). If the article described the use of a tool without describing the tool, the original article describing the development of the tool was searched by bibliographic mining or by contacting authors. In the end, we only included those original articles.
      Using a table completed by one author (J.G.) and checked by the other authors (V.B., A.-E.A.), we gathered data on the tools regarding information source, availability of a publication, origin, language, administration format, item number, branching logic, administration time, setting, timing, target age group, and coverage of HEEADSSSSS domains. Given that some tools present multiple versions depending on patient age, we analyzed each version separately. When possible, we extracted data directly from the full tool made available in the publication or after contacting the author.
      Finally, we summarized the data using simple proportions.
      In a second step, we mapped the quality measures assessed for the included tools. In addition to using information found in the original articles, we also searched for other sources. Consequently, in June 2020, we conducted a limited search in Embase and Google Scholar combining quality concepts and the tools' names (the complete search strategies can be found in Appendix B).

      Results

      Search results, source, and publication

      The search strategy identified 16 records describing a total of 15 different tools. The full study selection process is detailed in Figure 1. Less than half of the original articles or tools (6/15) were found through the database search, whereas most (9/15) were found through grey literature search (2/9 Google Scholar, 5/9 bibliographic mining, 2/9 contacting experts). Almost all tools (14/15) have a publication describing their development. When a more recent version of the tool could be found, data were extracted from this version.
      Figure thumbnail gr1
      Figure 1Flow chart of articles and tools selection.
      The key characteristics of the tools are described in Table 1, Table 2, Table 3.
      Table 1Overview of the tools
      Tool name/measureAbbreviationYear of publication (article)Language of toolCountryWorld bank country classificationSource
      Previsit Questionnaire (PVQ) [
      • Lewin W.
      • Knauper B.
      • Roseman M.
      • et al.
      Detecting and addressing adolescent issues and concerns: Evaluating the efficacy of a primary care previsit questionnaire.
      ]
      PVQ2009EnglishCanadaHigh incomeDatabase
      YouthChat [
      • Goodyear-Smith F.
      • Martel R.
      • Darragh M.
      • et al.
      Screening for risky behaviour and mental health in young people: The YouthCHAT programme.
      ]
      YouthChat2017English, MaoriNew ZealandHigh incomeDatabase
      Guide d'entretien confidentiel—early adolescents
      For this tool, a more recent version was used.
      , [
      • Dafflon M.
      • Michaud P.A.
      A clinical questionnaire for facilitating consultation with the adolescent.
      ]
      GEC-early2000FrenchSwitzerlandHigh incomeDatabase
      Guide d'entretien confidentiel—late adolescents/young adults
      For this tool, a more recent version was used.
      , [
      • Dafflon M.
      • Michaud P.A.
      A clinical questionnaire for facilitating consultation with the adolescent.
      ]
      GEC-late2000FrenchSwitzerlandHigh incomeDatabase
      Behavioral Health Screen (BHS) [
      • Diamond G.
      • Levy S.
      • Bevans K.B.
      • et al.
      Development, validation, and utility of internet-based, behavioral health screen for adolescents.
      ]
      BHS2010EnglishU.S.High incomeDatabase
      Questionnaire pré-consultation [
      • Alvin P.
      Questionnaire pré-consultation.
      ]
      QPCN/AFrenchFranceHigh incomeGrey literature (bibliographic mining)
      Check Up GP [
      • Webb M.J.
      • Wadley G.
      • Sanci L.A.
      Improving patient-centered care for young people in general practice with a codesigned screening app: Mixed methods study.
      ]
      Check Up GP2017EnglishAustraliaHigh incomeGrey literature (Google Scholar)
      HEADSS on Tickit Health
      For this tool, a more recent version was used.
      , [
      • Whitehouse S.R.
      • Lam P.Y.
      • Balka E.
      • et al.
      Co-creation with TickiT: Designing and evaluating a clinical eHealth platform for youth.
      ,
      Maari Ma Health Aboriginal Corporation
      Maari Ma TickiT evaluation report.
      ]
      Tickit2013EnglishAustraliaHigh incomeGrey literature (contacting experts)
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_9-12
      For this tool, a more recent version was used.
      , [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      RAAPS 19-242009EnglishU.S.High incomeGrey literature (bibliographic mining)
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_13-18
      For this tool, a more recent version was used.
      , [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      RAAPS 13-182009EnglishU.S.High incomeGrey literature (bibliographic mining)
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_19-24
      For this tool, a more recent version was used.
      , [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      RAAPS 9-122009EnglishU.S.High incomeGrey literature (bibliographic mining)
      Adolescent Health Review (AHR) [
      • Harrison P.A.
      • Beebe T.J.
      • Park E.
      The adolescent health review: A brief, multidimensional screening instrument.
      ]
      AHR2001EnglishU.S.High incomeDatabase
      Behaviour evaluation for risk-taking adolescents (BERTA) [
      • Suris J.C.
      • Nebot M.
      • Parera N.
      Behaviour evaluation for risk-taking adolescents (BERTA): An easy to use and assess instrument to detect adolescent risky behaviours in a clinical setting.
      ]
      BERTA2005CatalanSpainHigh incomeGrey literature (Google Scholar)
      The Multidimensional Adolescent Assessment Scale (MAAS) [
      • Mathiesen S.G.
      • Cash S.J.
      • Hudson W.W.
      The multidimensional adolescent assessment scale: A validation study:.
      ]
      MAAS2002EnglishU.S.High incomeGrey literature (bibliographic mining)
      Health eTouch system [
      • Stevens J.
      • Kelleher K.J.
      • Gardner W.
      • et al.
      Trial of computerized screening for adolescent behavioral concerns.
      ]
      eTouch2008EnglishU.S.High incomeDatabase
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—Younger adolescents [
      ]
      ASQ-young2010EnglishU.S.High incomeGrey literature (contacting experts)
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—Early adolescents [
      ]
      ASQ-early2010EnglishU.S.High incomeGrey literature (contacting experts)
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—15–17 years [
      ]
      ASQ-15-172010EnglishU.S.High incomeGrey literature (contacting experts)
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—18–21 years [
      ]
      ASQ-18-212010EnglishU.S.High incomeGrey literature (contacting experts)
      Patient screening form (PSF) [
      • Anand V.
      • Carroll A.E.
      • Downs S.M.
      Automated primary care screening in pediatric waiting rooms.
      ]
      PSF2012English, SpanishU.S.High incomeGrey literature (bibliographic mining)
      Risky Behavior Questionnaire for Adolescents (RBQ-A) [
      • Auerbach R.P.
      • Gardiner C.K.
      Moving beyond the trait conceptualization of self-esteem: The prospective effect of impulsiveness, coping, and risky behavior engagement.
      ]
      RBQ-A2012EnglishU.S.High incomeGrey literature (bibliographic mining)
      a For this tool, a more recent version was used.
      Table 2Tools' selected characteristics
      Tool name/measureAdministration (electronic vs. pen and paper)Maximum number of itemsBranch logicAdministration time (minutes)Timing (tested)Setting (tested)Age rangeEarly adolescents (10–14)Late adolescents (15–19)Young adults (20–24)
      Previsit Questionnaire (PVQ) [
      • Lewin W.
      • Knauper B.
      • Roseman M.
      • et al.
      Detecting and addressing adolescent issues and concerns: Evaluating the efficacy of a primary care previsit questionnaire.
      ]
      Pen and paper14NoN/A
      N/A stands for not applicable.
      OpportunisticOutpatient—primary care13–19YesYesNo
      YouthChat [
      • Goodyear-Smith F.
      • Martel R.
      • Darragh M.
      • et al.
      Screening for risky behaviour and mental health in young people: The YouthCHAT programme.
      ]
      Electronic87YesN/AOpportunisticOutpatient—primary care10–24YesYesYes
      Guide d'entretien confidentiel—early adolescents [
      • Dafflon M.
      • Michaud P.A.
      A clinical questionnaire for facilitating consultation with the adolescent.
      ]
      Pen and paper38No15OpportunisticOutpatient—primary care10–14YesNoNo
      Guide d'entretien confidentiel—late adolescents/young adults [
      • Dafflon M.
      • Michaud P.A.
      A clinical questionnaire for facilitating consultation with the adolescent.
      ]
      Pen and paper52No15OpportunisticOutpatient—primary care14–22NoYesYes
      Behavioral Health Screen (BHS) [
      • Diamond G.
      • Levy S.
      • Bevans K.B.
      • et al.
      Development, validation, and utility of internet-based, behavioral health screen for adolescents.
      ]
      Electronic112Yes8–15, 12.4OpportunisticOutpatient—primary care12–21YesYesYes
      Questionnaire pré-consultation [
      • Alvin P.
      Questionnaire pré-consultation.
      ]
      Pen and paper43NoN/AN/AN/AN/AN/AN/AN/A
      Check Up GP [
      • Webb M.J.
      • Wadley G.
      • Sanci L.A.
      Improving patient-centered care for young people in general practice with a codesigned screening app: Mixed methods study.
      ]
      Electronic64YesN/ARoutine scheduledOutpatient—primary care14–25YesYesYes
      HEADSS on Tickit Health [
      • Whitehouse S.R.
      • Lam P.Y.
      • Balka E.
      • et al.
      Co-creation with TickiT: Designing and evaluating a clinical eHealth platform for youth.
      ,
      Maari Ma Health Aboriginal Corporation
      Maari Ma TickiT evaluation report.
      ]
      Electronic87Yes4–24, 13Routine scheduledOutpatient—primary care12–18YesYesNo
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_9-12 [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      Electronic and pen and paper22No5–10OpportunisticSchool9–12YesNoNo
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_13-18 [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      Electronic and pen and paper22No5–10OpportunisticSchool13–18YesYesNo
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_19-24 [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      Electronic and pen and paper23No5–10OpportunisticSchool19–24NoNoYes
      Adolescent Health Review (AHR) [
      • Harrison P.A.
      • Beebe T.J.
      • Park E.
      The adolescent health review: A brief, multidimensional screening instrument.
      ]
      Electronic33N/A3OpportunisticSchool12–18YesYesNo
      Behaviour evaluation for risk-taking adolescents (BERTA) [
      • Suris J.C.
      • Nebot M.
      • Parera N.
      Behaviour evaluation for risk-taking adolescents (BERTA): An easy to use and assess instrument to detect adolescent risky behaviours in a clinical setting.
      ]
      Pen and paper9NoN/AN/ASchool14–19YesYesNo
      The Multidimensional Adolescent Assessment Scale (MAAS) [
      • Mathiesen S.G.
      • Cash S.J.
      • Hudson W.W.
      The multidimensional adolescent assessment scale: A validation study:.
      ]
      Pen and paper177No15–20OpportunisticN/A10–20YesYesYes
      Health eTouch system [
      • Stevens J.
      • Kelleher K.J.
      • Gardner W.
      • et al.
      Trial of computerized screening for adolescent behavioral concerns.
      ]
      Electronic101Yes12.5OpportunisticOutpatient—primary care11–18YesYesNo
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—younger adolescents [
      ]
      Pen and paper45NoN/AN/AN/AN/AYesNoNo
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—early adolescents [
      ]
      Pen and paper59YesN/AN/AN/AN/AYesNoNo
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—15–17 years [
      ]
      Pen and paper50YesN/AN/AN/A15–17NoYesNo
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—18–21 years [
      ]
      Pen and paper51YesN/AN/AN/A18–21NoNoYes
      Patient screening form (PSF) [
      • Anand V.
      • Carroll A.E.
      • Downs S.M.
      Automated primary care screening in pediatric waiting rooms.
      ]
      Pen and paper20NoN/ARoutine scheduledOutpatient—primary care12–21YesYesYes
      Risky Behavior Questionnaire for Adolescents (RBQ-A) [
      • Auerbach R.P.
      • Gardiner C.K.
      Moving beyond the trait conceptualization of self-esteem: The prospective effect of impulsiveness, coping, and risky behavior engagement.
      ]
      Pen and paper20No3–4N/AOutpatient—primary care, school12–18YesYesNo
      a N/A stands for not applicable.
      Table 3Key domains included in the tools
      Tool name/measureHomeEducation/employmentEatActivities, physicalActivities, socializationDrugs, licitDrugs, illicitSexualitySuicide/depressionSafety/securityScreenStrengthsOtherOther explanation
      Previsit Questionnaire (PVQ) [
      • Lewin W.
      • Knauper B.
      • Roseman M.
      • et al.
      Detecting and addressing adolescent issues and concerns: Evaluating the efficacy of a primary care previsit questionnaire.
      ]
      YesYesYesYesNoYesYesYesYesYesNoNoYesAppearance
      YouthChat [
      • Goodyear-Smith F.
      • Martel R.
      • Darragh M.
      • et al.
      Screening for risky behaviour and mental health in young people: The YouthCHAT programme.
      ]
      YesYesYesYesNoYesYesYesYesYesNoNoYesDemographics
      Guide d'entretien confidentiel—early adolescents [
      • Dafflon M.
      • Michaud P.A.
      A clinical questionnaire for facilitating consultation with the adolescent.
      ]
      YesYesYesYesYesYesYesYesYesYesYesYesYesGeneral state, medicine, appearance
      Guide d'entretien confidentiel—late adolescents/young adults [
      • Dafflon M.
      • Michaud P.A.
      A clinical questionnaire for facilitating consultation with the adolescent.
      ]
      YesYesYesYesYesYesYesYesYesYesYesYesYesGeneral state, medicine, appearance
      Behavioral Health Screen (BHS) [
      • Diamond G.
      • Levy S.
      • Bevans K.B.
      • et al.
      Development, validation, and utility of internet-based, behavioral health screen for adolescents.
      ]
      YesYesYesYesYesYesYesYesYesYesNoYesYesDemographics, general state, satisfaction
      Questionnaire pré-consultation [
      • Alvin P.
      Questionnaire pré-consultation.
      ]
      YesYesYesYesYesYesYesYesYesYesNoYesYesMedicine, appearance, open question
      Check Up GP [
      • Webb M.J.
      • Wadley G.
      • Sanci L.A.
      Improving patient-centered care for young people in general practice with a codesigned screening app: Mixed methods study.
      ]
      YesYesYesYesYesYesYesYesYesYesNoYesYesDemographics, appearance, medicine, satisfaction
      HEADSS on Tickit Health [
      • Whitehouse S.R.
      • Lam P.Y.
      • Balka E.
      • et al.
      Co-creation with TickiT: Designing and evaluating a clinical eHealth platform for youth.
      ,
      Maari Ma Health Aboriginal Corporation
      Maari Ma TickiT evaluation report.
      ]
      YesYesYesYesYesYesYesYesYesYesYesYesYesAboriginal, appearance, satisfaction
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_9-12 [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      NoNoYesYesYesYesYesYesYesYesYesYesYesDemographics
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_13-18 [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      YesYesYesYesNoYesYesYesYesYesNoYesYesDemographics
      Rapid Assessment for Adolescent Preventive Services (RAAPS)_19-24 [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ]
      NoNoYesYesNoYesYesYesYesYesNoNoYesDemographics
      Adolescent Health Review (AHR) [
      • Harrison P.A.
      • Beebe T.J.
      • Park E.
      The adolescent health review: A brief, multidimensional screening instrument.
      ]
      YesYesYesYesNoYesYesYesYesYesNoNoYesDemographics
      Behaviour evaluation for risk-taking adolescents (BERTA) [
      • Suris J.C.
      • Nebot M.
      • Parera N.
      Behaviour evaluation for risk-taking adolescents (BERTA): An easy to use and assess instrument to detect adolescent risky behaviours in a clinical setting.
      ]
      YesYesNoNoYesNoNoNoNoNoNoNoYesDemographics
      The Multidimensional Adolescent Assessment Scale (MAAS) [
      • Mathiesen S.G.
      • Cash S.J.
      • Hudson W.W.
      The multidimensional adolescent assessment scale: A validation study:.
      ]
      YesYesNoNoYesYesYesNoYesYesNoNoYesCognition: memory loss
      Health eTouch system [
      • Stevens J.
      • Kelleher K.J.
      • Gardner W.
      • et al.
      Trial of computerized screening for adolescent behavioral concerns.
      ]
      NoNoNoNoNoYesYesNoYesYesNoNoNono
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—younger adolescents [
      ]
      YesYesYesYesYesYesYesYesYesYesYesYesYesDemographics, access to medical care
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—early adolescents [
      ]
      YesYesYesYesYesYesYesYesYesYesYesYesYesDemographics, access to medical care, piercing and tattoos
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—15–17 years [
      ]
      YesYesYesYesYesYesYesYesYesYesYesNoYesDemographics, access to medical care, piercing and tattoos
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)—18–21 years [
      ]
      YesYesYesYesYesYesYesYesYesYesYesNoYesDemographics, access to medical care, piercing and tattoos
      Patient screening form (PSF) [
      • Anand V.
      • Carroll A.E.
      • Downs S.M.
      Automated primary care screening in pediatric waiting rooms.
      ]
      Variable
      Variable because the items are based on an algorithm considering the patients' age and electronic medical record.
      VariableVariableVariableVariableVariableVariableVariableVariableVariableVariableVariableVariableVariable
      Risky Behavior Questionnaire for Adolescents (RBQ-A) [
      • Auerbach R.P.
      • Gardiner C.K.
      Moving beyond the trait conceptualization of self-esteem: The prospective effect of impulsiveness, coping, and risky behavior engagement.
      ]
      YesYesYesNoYesYesYesYesYesYesNoNoYesShoplifting, gambling
      a Variable because the items are based on an algorithm considering the patients' age and electronic medical record.

      Origin and language

      The origin and language of the tools are shown in Table 1.
      All tools without exception were developed in high-income countries (HIC). Most tools (12/15) were developed in Anglophone countries and are, therefore, in English, whereas the remaining tools were developed in Switzerland, Spain, and France. Two tools offer two language options: English-Maori and English-Spanish.

      Administration

      The administration format of the tools is shown in Table 2.
      Almost half of the tools (7/15) are available in an electronic format. Only one tool also exists in a paper format. As of 2010, most tools (4/7) use an electronic format, mainly as an application on a smartphone, tablet, and/or computer.

      Item number, branch logic, and administration time

      The item number, branch logic, and administration time of the tools are shown in Table 2.
      The maximum number of items varies from 9 to 177. Only a minority (6/15) uses branch logic—i.e., question pathway based on the respondent's answers. The administration time is often not specified but when it is, in eight of the tools, it ranges from 3 to 20 minutes and increases with more items, although not proportionally.

      Setting and timing

      The setting and timing of the tools are shown in Table 2.
      The setting and timing for which the tool was developed and applied may differ from those recommended by the authors. For example, some instruments were developed for school settings but also recommended for use in primary care outpatient facilities [
      • Harrison P.A.
      • Beebe T.J.
      • Park E.
      The adolescent health review: A brief, multidimensional screening instrument.
      ]. Similarly, tools used to collect data opportunistically were recommended for use in routine clinical scheduled visits [
      • Harrison P.A.
      • Beebe T.J.
      • Park E.
      The adolescent health review: A brief, multidimensional screening instrument.
      ].
      Eight tools have been used exclusively in an outpatient primary care setting, whereas three have been used at school. One has been used in both settings. Nonetheless, based on the authors' recommendations, three tools can be used in both primary care and school settings [
      • Goodyear-Smith F.
      • Martel R.
      • Darragh M.
      • et al.
      Screening for risky behaviour and mental health in young people: The YouthCHAT programme.
      ,
      • Harrison P.A.
      • Beebe T.J.
      • Park E.
      The adolescent health review: A brief, multidimensional screening instrument.
      ,
      • Auerbach R.P.
      • Gardiner C.K.
      Moving beyond the trait conceptualization of self-esteem: The prospective effect of impulsiveness, coping, and risky behavior engagement.
      ].

      Age

      The targeted age groups of the tools are shown in Table 2.
      Our target group is adolescents and young adults aged 10–24 years. Eight tools cover the entire age group, of which three have multiple versions depending on the patient's age. Only two tools cover the young adult age group exclusively by using a version adapted to the patient's age.

      HEEADSSSSS domains

      The domains covered by each tools are shown in Table 3.
      A domain is covered if at least one of the age-adapted versions of the tool mentions it. Some HEAADSSS domains such as Home (13/15), Education and employment (13/15), Eating (11/15), physical Activity (10/15), socialization Activities (10/15), licit and illicit Drugs (13/15), Sexuality (11/15), Suicide and depression (13/15), and Safety and security (13/15) are covered by almost all the tools, whereas others such as Screens (4/15) and Strengths (7/15) are often not addressed.
      Some tools had questions addressing domains not included in the acronym. They often covered demographic information, general state and appearance and less frequently gambling and access to medical care.

      Quality assessment of the tools

      The quality measures used to assess the tools are shown in Table 4.
      Table 4Quality assessment of the tools
      Tool name/measureType of quality assessment
      The terms listed are the ones used by the authors. If no term was specified in their article, we chose the ones we considered most appropriate.
      Summary
      Previsit Questionnaire (PVQ) [
      • Lewin W.
      • Knauper B.
      • Roseman M.
      • et al.
      Detecting and addressing adolescent issues and concerns: Evaluating the efficacy of a primary care previsit questionnaire.
      ]
      Efficacy- Increases the number of psychosocial issues without diagnoses recorded and the number of psychosocial actions taken, decreases the number of medical actions taken suggesting that it increases physician awareness of psychosocial issues
      YouthChat [
      • Thabrew H.
      • D'Silva S.
      • Darragh M.
      • et al.
      Comparison of YouthCHAT, an electronic composite psychosocial screener, with a clinician interview assessment for young people: Randomized controlled trial.
      ,
      • Goodyear-Smith F.
      • Corter A.
      • Suh H.
      Electronic screening for lifestyle issues and mental health in youth: A community-based participatory research approach.
      ]
      Acceptability (provider), acceptability (patient), utility, effectiveness- For patients: easy to use, gives them time to reflect on their responses and what to discuss with their clinician

      - For providers: makes consultations faster, helps to guide their conversation and address sensitive issues

      - To be improved: interface could be more appealing, student literacy issues
      Guide d'entretien confidentielN/A
      N/A stands for not applicable.
      Behavioral Health Screen (BHS) [
      • Diamond G.
      • Levy S.
      • Bevans K.B.
      • et al.
      Development, validation, and utility of internet-based, behavioral health screen for adolescents.
      ,
      • Diamond G.
      • Herres J.
      • Krauthamer Ewing E.
      • et al.
      Comprehensive screening for suicide risk in primary care.
      ,
      • Herres J.
      • Kodish T.
      • Fein J.
      • Diamond G.
      Screening to identify groups of pediatric emergency department patients using latent class analysis of reported suicidal ideation and behavior and non-suicidal self-injury.
      ,
      • Bevans K.
      • Diamond G.
      • Levy S.
      Screening for adolescents' internalizing symptoms in primary care: Item response theory analysis of the behavior health screen depression, anxiety, and suicidal risk scales.
      ]
      Validity, reliability, utility, acceptability (provider), acceptability (patient), sensitivity, specificity- Strong internal consistency as well as impressive convergent and divergent validity. High specificity and sensitivity

      - For patients: user-friendly, helpful during the appointment

      - For providers: helps to identify patients with internalizing symptoms and/or at-risk for suicide, helps to facilitate and plan the visit
      Questionnaire pré-consultationN/A
      Check Up GP [
      • Webb M.J.
      • Wadley G.
      • Sanci L.A.
      Improving patient-centered care for young people in general practice with a codesigned screening app: Mixed methods study.
      ,
      • Larsen M.
      • Gardner K.
      • Webb M.J.
      • et al.
      Experiences of general practitioners and practice support staff using a health and lifestyle screening app in primary health care: Implementation case study.
      ]
      Utility, acceptability (patient)- For patients: gives a chance to prepare and reflect on their responses

      - For providers: improves disclosure, expanding patient understanding of the scope of what their provider can help them with

      - To be improved: privacy during completion
      HEADSS on Tickit Health [
      • Whitehouse S.R.
      • Lam P.Y.
      • Balka E.
      • et al.
      Co-creation with TickiT: Designing and evaluating a clinical eHealth platform for youth.
      ,
      Maari Ma Health Aboriginal Corporation
      Maari Ma TickiT evaluation report.
      ]
      Acceptability (provider), acceptability (patient), utility- For patients: easy to use, comfortable with the questions asked, helps them talk with their provider

      - For providers: saves time, offers a non-judgmental way for young people to provide answers to difficult questions
      Rapid Assessment for Adolescent Preventive Services (RAAPS) [
      • Yi C.H.
      • Martyn K.
      • Salerno J.
      • Darling-Fisher C.S.
      Development and clinical use of rapid assessment for adolescent preventive services (RAAPS) questionnaire in school-based health centers.
      ,
      • Suarez-Pinto T.A.
      • Blanco-Gomez A.
      • Diaz-Martinez L.A.
      Validation of the Spanish-language version of the rapid assessment for adolescent preventive services among Colombian adolescents.
      ,
      • Salerno J.
      • Marshall V.D.
      • Picken E.B.
      Validity and reliability of the rapid assessment for adolescent preventive services adolescent health risk assessment.
      ,
      • Salerno J.
      • Barnhart S.
      Evaluation of the RAAPS risk screening tool for use in detecting adolescents with depression.
      ,
      • Darling-Fisher C.
      • Salerno J.
      • Dahlem C.
      • Martyn K.
      The rapid assessment for adolescent preventive services (RAAPS): Providers' assessment of its usefulness in their clinical practice settings.
      ]
      Effectiveness, reliability, validity, specificity, sensitivity, acceptability (provider), utility- Validity and reliability established with good internal consistency, content validity and face validity. Strong specificity and sensitivity

      - For providers: encourages communication and disclosure, time efficient, easy to use, comprehensive risk assessment

      - To be improved: mostly not valid in Colombia
      Adolescent Health ReviewN/A
      Behaviour evaluation for risk-taking adolescents (BERTA) [
      • Suris J.C.
      • Nebot M.
      • Parera N.
      Behaviour evaluation for risk-taking adolescents (BERTA): An easy to use and assess instrument to detect adolescent risky behaviours in a clinical setting.
      ]
      Utility- Good instrument to detect adolescents with at least one risky behavior; youth with a score higher than 1 are more than twice as likely to have any risky behavior
      The Multidimensional Adolescent Assessment Scale (MAAS) [
      • Mathiesen S.G.
      • Cash S.J.
      • Hudson W.W.
      The multidimensional adolescent assessment scale: A validation study:.
      ]
      Validity, reliability- Reliable and valid method of measuring multiple domains of functioning
      Health eTouch system [
      • Stevens J.
      • Kelleher K.J.
      • Gardner W.
      • et al.
      Trial of computerized screening for adolescent behavioral concerns.
      ]
      Utility, feasibility- Standardized behavioral screening is feasible in pediatric primary care clinic through computerized technology

      - May help initiate conversation with providers on topics that otherwise would not have been discussed
      Bright Futures Adolescent Supplemental Questionnaire (ASQ)N/A
      Patient screening form (PSF) [
      • Anand V.
      • Carroll A.E.
      • Downs S.M.
      Automated primary care screening in pediatric waiting rooms.
      ]
      Utility- Significantly decreases the burden of identifying relevant guidelines and screening
      Risky Behavior Questionnaire for Adolescents (RBQ-A)N/A
      a The terms listed are the ones used by the authors. If no term was specified in their article, we chose the ones we considered most appropriate.
      b N/A stands for not applicable.
      Ten tools have been assessed by quality measures in at least one publication. Utility was measured for eight tools whereas effectiveness for two tools, efficacy and feasibility for one tool each. Acceptability by providers or patients was evaluated for four tools. Validity and reliability were measured for three tools, sensitivity and specificity for two. Overall, the quality measures chosen by the authors are very heterogeneous.

      Discussion

      This systematic review sheds light on 15 existing previsit multidomain psychosocial screening tools developed since 2000, to improve the detection of common health issues and needs among adolescents and young adults. Results highlight no representation of low- and middle-income countries (LMIC) in the development stage, heterogeneous quality assessment, and diversity in the format and setting for use. Only a few tools were spanned into young adulthood.
      All tools have been developed in HIC, underscoring an undeniable disparity between research on previsit tools in HIC and LMIC. Even though these groups have different needs and challenges, the use of previsit screening tools could potentially be of benefit in both settings [
      World Health Organization
      Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation.
      ,
      • Azzopardi P.S.
      • Hearps S.J.C.
      • Francis K.L.
      • et al.
      Progress in adolescent health and wellbeing: Tracking 12 headline indicators for 195 countries and territories, 1990-2016.
      ]. In terms of global burden of disease in adolescents, countries are progressing at a different pace through the epidemiological transition: LMIC face multiple burdens with higher rates of communicable, maternal, and nutritional conditions whereas almost all HIC face noncommunicable diseases. In between are countries that have a preponderance of injuries. LMIC are also characterized by an acute lack of resources in infrastructure, staff, and professional training [
      • Sawyer S.M.
      • Baltag V.
      Toward an adolescent competent workforce.
      ,
      World Health Organization
      Human resources for health: Foundation for universal health coverage and the post-2015 development agenda: Report of the third global forum on human resources for health.
      ,
      • Kokotailo P.K.
      • Baltag V.
      • Sawyer S.M.
      Educating and training the future adolescent health workforce.
      ]. On the other hand, HIC face growing budgetary pressures that lead to procurement strategies and policies aimed at maximizing the amount of patient care at the lowest cost to the local authority [
      The Health Foundation
      Need to nurture: Outcomes-based commissioning in the NHS.
      ,
      PricewaterhouseCoopers
      ]. In sum, both groups face substantial time and effectiveness constraints.
      The use of a previsit tool could be a promising response by increasing the efficiency of provider-patient encounters regardless of geographical context, and helping to overcome some of the aforementioned barriers [
      • Ozer E.M.
      • Adams S.H.
      • Lustig J.L.
      • et al.
      Can it be done? Implementing adolescent clinical preventive services.
      ,
      • Bradford S.
      • Rickwood D.
      Psychosocial assessments for young people: A systematic review examining acceptability, disclosure and engagement, and predictive utility.
      ,
      • Ozer E.M.
      • Adams S.H.
      • Lustig J.L.
      • et al.
      Increasing the screening and counseling of adolescents for risky health behaviors: A primary care intervention.
      ]. Taking a psychosocial history that allows for the identification of resources, treatment opportunities, and detection of risks is universal irrespective of geographic context. However, the implementation of previsit tools will depend on local culture, traditions, religious beliefs, socioeconomic and political factors, particularly by influencing both what and how questions are asked and answered [
      • Azzopardi P.S.
      • Hearps S.J.C.
      • Francis K.L.
      • et al.
      Progress in adolescent health and wellbeing: Tracking 12 headline indicators for 195 countries and territories, 1990-2016.
      ]. The adaptability of a universal tool implies that the domains covered should be similar, but individual items may be adapted to the local context.
      The quality assessment of the 15 existing tools showed that measures of validity or reliability were scarce and not standardized. Despite widespread recommendations for psychosocial screening, it is surprising that so little research has been carried out on its effectiveness. That said, the main aim for such tools is their ability to facilitate early detection which may lead to a long-term positive impact on patient health. To develop a “gold standard” previsit screening tool, their psychometric properties, their validity, and their effectiveness and acceptability for patients and providers need to be assessed. Implementing routine previsit assessment requires not only an effective screening tool but also major changes in health systems. These include insurance coverage, availability of health care services, and availability of adolescent-friendly health care providers with adolescent-specific health knowledge.
      In terms of administration, more than half of the tools are electronic, providing further evidence that digital technology is gaining more ground. In many countries such as the U.S., 95% of teens have access to a smartphone [
      • Anderson M.
      • Jiang J.
      Teens, social media & technology 2018.
      ], whereas this rate is lower in LMIC and varies greatly between urban and rural areas [
      • Porter G.
      • Hampshire K.
      • Abane A.
      • et al.
      Youth, mobility and mobile phones in africa: Findings from a three-country study.
      ]. The increase of smartphone ownership in both HIC and LMIC [
      • Poushter J.
      Smartphone ownership and internet usage continues to climb in emerging economies.
      ,
      • Taylor K.
      • Silver L.
      Smartphone ownership is growing rapidly around the world, but not always equally.
      ] has an impact on the way adolescents and young adults gain health literacy, with over half seeking health information online [
      • Reid Chassiakos Y.L.
      • Radesky J.
      • Christakis D.
      • et al.
      Children and adolescents and digital media.
      ,
      • Borzekowski D.L.
      • Fobil J.N.
      • Asante K.O.
      Online access by adolescents in accra: Ghanaian teens' use of the internet for health information.
      ]. This observation urges a better integration of technology into clinical practice with important reflections to be made on the implementation of previsit screening tools. First, a robust platform that is well integrated with the patient's electronic health record provides the ideal infrastructure. There should be a way to track changes over time and generate statistics. Second, as with any health-related data, confidentiality and data protection should be guaranteed [
      National eHealth strategy toolkit.
      ]. This raises issues of encryption and storage of sensitive information. Third, a high level of user-friendliness will encourage high adoption rates among both patients and providers. For example, the professional should be able to identify easily the most challenging areas on a results dashboard and thus prioritize quickly.
      Despite the important role of previsit psychosocial screening in the care of adolescents and young adults, it is essential to remember that screening is only a first step in care [
      • Ham P.
      • Allen C.
      Adolescent health screening and counseling.
      ]. In fact, inquiring about intimate and health issues also raises patient expectations and requires the provider to react. Not reacting to a detected problem could be even more harmful than not screening at all [
      • Bradford S.
      • Rickwood D.
      Psychosocial assessments for young people: A systematic review examining acceptability, disclosure and engagement, and predictive utility.
      ]. In reality, many health professionals feel that they are inadequately equipped to manage the psychosocial issues of adolescents and young adults [
      • Emans S.J.
      • Bravender T.
      • Knight J.
      • et al.
      Adolescent medicine training in pediatric residency programs: Are we doing a good job?.
      ]. Because screening tools coupled with brief interventions have already proven their worth and can lead to better health outcomes [
      • Sanci L.
      • Grabsch B.
      • Chondros P.
      • et al.
      The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice.
      ], targeted training sessions for brief clinical interventions should accompany the introduction of a previsit psychosocial screening tool [
      World Health Organization
      Adolescent job aid: A handy desk reference tool for primary level health workers.
      ,
      • Sanci L.
      • Chondros P.
      • Sawyer S.
      • et al.
      Responding to young people's health risks in primary care: A cluster randomised trial of training clinicians in screening and motivational interviewing.
      ]. Ideally, this would be a brief and specific individualized intervention undertaken by the professional and integrated with the tool [
      • Zieve G.G.
      • Richardson L.P.
      • Katzman K.
      • et al.
      Adolescents' perspectives on personalized E-feedback in the context of health risk behavior screening for primary care: Qualitative study.
      ].
      Almost half of the tools reviewed do not include the young adult age group as a target. Yet, young adults are still in a period of vulnerability and still present an important morbidity associated with psychosocial domains [
      Committee on Improving the Health S, and Well-Being of Young AdultsBoard on Children, Youth, and FamiliesInstitute of MedicineNational Research Council
      Investing in the health and well-being of young adults.
      ]. Developing a previsit screening tool covering the 20- to 24-year-old age group could potentially improve the effectiveness of the clinical encounter with young adults. Making the tool available in various versions, or using a branch logic depending on the age of the patient, are effective ways to ensure it is adapted to their situation and level of understanding.
      Finally, the HEEADSSS acronym should continue its expansion to include new issues that have health repercussions, such as the exponential rise in screen use that is associated with problems spanning family conflict, sleep disturbance, and somatic problems, to name only a few [
      • Levenson J.C.
      • Shensa A.
      • Sidani J.E.
      • et al.
      The association between social media use and sleep disturbance among young adults.
      ,
      • Hakala P.T.
      • Rimpela A.H.
      • Saarni L.A.
      • Salminen J.J.
      Frequent computer-related activities increase the risk of neck-shoulder and low back pain in adolescents.
      ]. Concurrently, the integration of a “strengths” category and thereby a more positive approach to youth development, such as the one adopted by the SSHADESS screen, would also allow professionals to promote and build on adolescents' resources and opportunities [
      • Ginsburg K.R.
      The SSHADESS screen: A strength-based psychosocial assessment.
      ].

      Limitations

      We did not conduct a systematic examination of every published article using the tools identified in our review. Therefore, there may be published evidence on some tools that has not been integrated in this review. In addition, even though we contacted as many experts and international organizations as possible, many unpublished tools may be used clinically. Indeed, our search was complicated by the sheer number of centers that could have been contacted worldwide.

      Conclusion

      Previsit multidomain psychosocial screening tools are used widely in clinical and school settings to detect risk-taking behaviors and strengths in adolescents and young adults. Acceptability by health care professionals is high, and evidence suggests that such tools are very useful. However, there is no current gold standard.
      Our review identified opportunities to improve the content and focus of existing previsit screening tools. Future research should focus on developing a validated tool for adolescents and young adults that could be adapted to local contexts in both LMIC and HIC. For this and all other tools, their psychometric properties, effectiveness, acceptability for both the patient and providers, and predictive utility should be evaluated.
      The implementation of a validated universal previsit multidomain screening tool in clinical practice would support professionals around the globe with their mandate in prevention and detection, including early identification of adolescent and young adult health needs. By enhancing systematic psychosocial health risk assessment and linking it to brief individualized interventions, their use may contribute to reducing the burden of ill health in adolescents around the world and yield long-term health benefits at both individual and collective levels.

      Acknowledgments

      The authors wish to express their gratitude to Cécile Jaques from Lausanne University Hospitals' Medical Library as well as Tomas Allen and José Luis Garnica from the World Health Organizations' Library and Information Networks for Knowledge for their valuable contribution to the search strategy. Nathalie Gons and Jen Wang proofread and edited the manuscript for language.
      Authors' contributions: Jérémy Glasner was the main author. He conceived the research question, developed the research strategy, screened the records, and drafted and revised the manuscript. Anne-Emmanuelle Ambresin and Valentina Baltag were supervisors of this project. They contributed equally to the conception of the research question, development of the research strategy, screening process, discussion of the results, and revision of various versions of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Jérémy Glasner was an Intern in the Department of Maternal, Newborn, Child, Adolescent Health and Ageing (MCA), World Health Organization (WHO), Geneva, Switzerland from October 2018 to February 2019.

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      Linked Article

      • Psychosocial Assessments After COVID-19
        Journal of Adolescent HealthVol. 68Issue 3
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          It is nearly 50 years since Dr Henry Berman first described his approach to routine psychosocial history taking with adolescents using the HEADS framework, an approach that is deeply appreciative of the nexus between biological development, social, and environmental interactions [1]. Berman's original framework slowly expanded into HEADSS and more recently HEEADDSSS [2,3], and other acronyms have flowered around similar approaches albeit with nuanced differences, such as the focus on strengths within SSHADESS [4].
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