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Adolescent Health Toolkit

Adolescents Health Toolkit: For Providers

This toolkit was developed following the 2009 EPSDT State Leadership Workshop, which focused on strengthening adolescent EPSDT services. The workshop resulted in four workgroups, one of which has focused on Improving the Quality of Adolescent Care. That workgroup completed a survey that assessed barriers perceived by providers in providing preventive services to adolescents. Based on the responses from that survey, the following tools were assembled to assist providers in offering quality care to adolescents.

Toolkit Contents:

Preventive/Well-Adolescent Visits

The American Academy of Pediatrics and Bright Futures recommends adolescents receive an annual well visit. Components of these annual visits should include: a complete health history (behavioral/developmental, physical, and dental); an unclothed (or appropriately draped) physical exam; lab tests as indicated; immunizations; hearing screen; vision screen; and anticipatory guidance (health education).

AAP/Bright Futures Periodicity Schedule - This periodicity schedule has a comprehensive listing of the recommended preventive care for adolescents.

TNAAP EPSDT Documentation Forms - The TN Chapter of the American Academy of Pediatrics has developed forms that comply with EPSDT screening guidelines for use by physicians. The Age 11-14 year-old exam form and the Age 15-19 year-old exam form are available for download.

EPSDT/TENNderCARE - TennCare (Tennessee's Medicaid program) has made a commitment to promoting good health in children from birth until age 21. TENNderCARE is a full program of check ups and health care services for children who have TennCare. These services make sure babies, children, teens and young adults receive the health care they need.

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Screening and Intervention Tools


Guidelines/Schedules

AAP/Bright Futures Periodicity Schedule - This periodicity schedule has a comprehensive listing of the recommended screenings that should be performed at adolescent visits.

American Medical Association Guidelines for Adolescent Preventive Services (GAPS) - These guidelines were developed by the American Medical Association to assist providers in delivering care to adolescents.

US Preventive Services Task Force - The US Preventive Services Task Force, sponsored by the Agency for Healthcare Research and Quality (AHRQ), publishes guidelines for screening and counseling related to a number of health and disease-specific conditions. The task force has specific recommendations for children and adolescents.

Physical Measurements

Body Mass Index (BMI) Screening - Bright Futures guidelines recommend measuring body mass index (BMI) annually for adolescents. The Centers for Disease Control and Prevention have standard BMI charts available for boys and for girls.

Blood Pressure Measurement - Bright Futures guidelines recommend measuring blood pressure annually for adolescents. Normal values for blood pressure in children are calculated according to the child's age and height. The National Heart, Lung, and Blood Institute (NHLBI) has a standard table available for download.

Developmental/Behavioral Assessments

Pediatric Symptom Checklist (PSC) - The Pediatric Symptom Checklist is a questionnaire for children ages 4-18 that can be completed by youth or by a parent. The tool is used to screen for emotional or behavioral disorders among children and adolescents. The questions address internalizing and externalizing, as well as attention issues.

Eyeberg Child Behavior Inventory (ECBI) - The ECBI is a questionnaire for parents of children ages 2-16. It is a behavioral rating scale of externalizing or conduct disorders.

Vanderbilt/NICHQ ADHD Toolkit - This toolkit has resources to aid providers in diagnosis and treatment of children with ADHD, as well as parent information and support and additional resources for providers related to coding, billing and reimbursement. Parent and teacher questionnaires (initial screening and follow-up) are included. This toolkit can be downloaded for free be registering at www.nichq.org.

Alcohol and Drug Use Assessments

CRAFFT Scale - The scale is a behavioral health screening tool for children under age 21 consisting of a series of 6 questions developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. The CRAFFT tool is available online at: http://www.ceasar-boston.org/CRAFFT/index.php.

Procedures (Immunizations and Laboratory Screenings)

Immunizations
Immunization status should be addressed annually at each preventive visit. The latest CDC vaccination schedules for adolescents can be found on the CDC website. For adolescents whose immunizations are delayed, a catch-up schedule is available.

Tennessee Immunization Requirements
The Tennessee Department of Health enforces the rules for immunization of children in the state. Required immunizations for all age groups (including the new requirements for adolescents) are available on the department's website.

Exam Techniques/Tools

GAPS Questionnaires
These questionnaires are part of the American Medical Association's "Guidelines for Adolescent Preventive Services," or "GAPS." The questionnaires allow adolescents to provide information about the reason for the visit, any health concerns and health risk behaviors. The screenings are available for multiple age groups (and parents) and in English and Spanish.

H.E.A.D.S.S
The H.E.A.D.S.S (Home, Environment, Activities, Drugs, Sexuality, Suicide/Depression) model is one approach to structuring an adolescent visit. More information is available in this summary document from the British Columbia Children's Hospital.

Motivational Interviewing
Motivational interviewing is a technique of interacting with patients to enhance their motivation to change a particular behavior. This technique can be used with adolescents. More information can be found online at Motivational Interview website.

Strengths-Based Approach
The strengths-based approach focuses on all the assets that an adolescent has (personal, family, community, etc) rather than emphasizing weaknesses or problem areas. More information is online at:

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Anticipatory Guidance

Bright Futures Guidelines
Anticipatory guidance includes education about nutrition, education, safety, and family lifestyle choices and should be provided annually to adolescents at the preventive visit. The Bright Futures Guidelines for Adolescents outlines specific topics that can be addressed during the annual visit.

AAP's Connected Kids Program
This AAP-developed program focuses on violence prevention in the community. The curriculum contains materials for providers, patients and families.

GAPS Screening and Health Guidance for Suicide and Depression
These tools compiled by the American Medical Association as part of the Guidelines for Adolescent Preventive Services ("GAPS"), provide a systematic approach that clinicians can use to approach adolescents regarding suicide and depression.

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Handouts & Educational Resources

Healthychildren.org Teen Pages
This website, created for parents and patients by the American Academy of Pediatrics, has information about common health conditions and information about parenting adolescents.

KidsHealth.org Teen Health Section
The KidsHealth.org site is maintained by Nemours and has a section devoted to health information for teens (http://kidshealth.org/teen/). A separate section of the site contains information for parents.

Young Women's Health
Created by Boston Children's Hospital, this website features health guides, quizzes, chats and more.

Young Men's Health
Created by Boston Children's Hospital, this website features health topics for young men, including information on nutrition and fitness, sexuality and health, health and development, and emotional health.

American Academy of Pediatrics Adolescent Health Resources
A collection of resources compiled by the AAP's Section on Adolescent Health. features provider and parent handouts, provider training and links to additional resources.

I Get It!
The I Get It! component of the TENNderCARE program focuses on the health of adolescents. The I Get It! website includes handouts on a variety of adolescent health topics that are available free for download.

Medline Plus Health Information for Children & Teenagers
Extensive listing of handouts on a variety of health topics compiled by the U.S. National Library of Medicine and the Institutes of Health.

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Confidentiality

Summary of Teen Rights in Tennessee
The TENNderCare program has created a summary of "Tennessee Youth Laws: Teen Rights" that outlines state laws around birth control, pregnancy, HIV/AIDS/STD testing, abortion, mental health care, substance abuse, and tattooing and piercing. The target audience for this document is the adolescent population.

Confidentiality Resources for Adolescent Providers
These resources were compiled by the Society for Adolescent Medicine and include a primer on protecting youth confidentiality, information on billing for confidential services, and a customizable document to describe your office's approach to confidential adolescent services.

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Coding Resources

TNAAP Coding Manual
The TN Chapter of the American Academy of Pediatrics (TNAAP) has published a coding manual that is available online.

Coding Training provided by TNAAP
TNAAP staff provides complimentary chart reviews of EPSDT visits to ensure medical record documentation meets the audit criteria for the seven EPSDT Components and documentation requirements. This includes an exit conference with physicians to discuss findings and recommendations, as well as a free follow-up training is offered if needed. TNAAP staff also provides complimentary chart reviews of Evaluation and Management services and procedures to ensure medical record documentation meets the criteria for Documentation Guidelines for Evaluation and Management services and CPT guidelines for procedural coding. If you are interested in receiving this training for yourself or for your office staff, please contact TNAAP.

Society for Adolescent Medicine-Billing and Coding Resources
These resources developed by the Society for Adolescent Medicine include information about billing and coding for confidential adolescent health services.

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Referral Resources

TN Disability Pathfinder
The TN Disability Pathfinder is an internet community and statewide helpline that can be accessed by providers or patients/parents. The database is searchable by location and category of services.

Map of TN Community Mental Health and Substance Abuse Services
This map is maintained by the TN Department of Mental Health and Developmental Disabilities. Users can click on their county to see a list of available providers with contact information listed for each provider.

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Provider Tools


Recall and Reminder Tools

The literature shows that using recall and reminder strategies, such as letters or postcards, can improve the show rate for patient appointments. Sample tools are below and available for download.

AAP Information on Immunization Recall/Reminder Systems
Summary document prepared by the American Academy of Pediatrics with information on various recall and reminder strategies.

AHRQ Reminder Postcard
Reminder postcard with information about immunizations and preventive care.

Washington Adolescent Reminder/Recall Postcard
Reminder postcard with information about the importance of well-child checkups and immunizations.

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Tools for Adolescent Vaccination

AdolescentVaccination.org
This website contains FREE downloadable phone scripts, reminder postcards and emails, newsletter articles, posters, and table tents.

Immunization Action Coalition-Standing Orders for Vaccines
These standing order protocols may be used in clinics to standardize immunization orders.

Tools for Talking with Parents About Vaccine Downloadable information you can use to talk with parents about vaccine-related topics.

It's Their Turn! Vaccine Initiative
Fun downloadable resources including posters, e-cards, web buttons, podcasts and videos to help providers educate teens and pre-teens about vaccinations.

CDC Pre-Teen Vaccination Campaign
Downloadable information including posters, fliers, web buttons, radio scripts and podcasts.

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TENNderCARE Tools

TENNderCARE is the Bureau of TennCare's EPSDT program for children ages birth-21. This is a is a full program of check ups and health care services for children who have TennCare. The following tools are available for free:

TENNderCARE Brochure
This brochure outlines the TENNderCARE program and explains the recommended preventive services. The brochure also contains information about the TennCare managed care organizations. The brochure is available in English and in Spanish.

TENNderCARE Publications
A variety of publications including brochures, flyers (in nine different languages), posters and links to videos.

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Miscellaneous Tools

Tennessee Department of Health Adolescent and Young Adult Health Program
This website contains numerous downloadable resources developed by the Tennessee Department of Health, with links to additional resources.

National Adolescent Health Information Center
The overall goal of NAHIC is to improve the health of adolescents by serving as a national resource for adolescent health information and research, and to assure the integration, synthesis, coordination and dissemination of adolescent health-related information.

NACCHO Maternal, Child, and Adolescent Health Toolkit
This toolkit contains downloadable resources highlighting programs and practices to help local health departments with their work related to Maternal and Child Health and Adolescent Health.

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