Social Media Screening Questions for Electronic Medical Record Systems

Question: We are interested in adding questions regarding social media use to the electronic medical record system (EMR) used in our outpatient Pediatric primary care centers. The target screening population would likely be preteens and adolescents, with the focus on identifying both positive, supportive uses of social media and also negative, detrimental social media usage. Is there an existing evidence-based social media screening questionnaire that we could incorporate into our EMR? Or, evidence-based questions that you could recommend we utilize?

Answer: While the AAP doesn’t endorse the use of specific social media screening tools, there are several existing questionnaires that your clinic might consider adding to your EMR. Most existing screening tools focus on specific social media or other digital media experiences such as problematic use or cyberbullying, rather than social media use broadly.  

To screen for problematic use: 

• The PRIUSS-3 is a 3-item screening tool that can be used to help identify problematic or risky internet use. If the screen is positive, clinicians can follow up with the full 18-item PRIUSS which includes three sub-scales: social impairment, emotional impairment, and risky/impulsive internet use.  
• You could also consider the HEADS-4 screening tool, which is an addition to the HEADSSS tool commonly used in pediatric and adolescent practices which assesses home life, education, activities, drugs, sexual activity, safety, suicide, and/or depression. This tool adds a fourth “S” to the HEADSSS acronym (making it HEADS-4) to assess social media usage. Notably, the HEADS-4 focuses on screen time and risks related to social media use including sexting, cyber-bullying, and predation (see image below).  

Clinician-focused resources that offer a balanced approach: 

Although the PRIUSS and HEADS-4 focus more on risks related to social media and digital media use, we recommend that clinicians take a balanced approach to assessing social media experiences with adolescent patients. While we are not aware of specific screening tools that assess positive experiences with social media, there are a few clinician-focused resources that outline a balanced approach that could be used to develop screening questions.  

• The Bright Futures guidelines, developed in collaboration with the AAP, outline health guidelines for pediatricians. The 4th edition of Bright Futures includes a new health theme called “Promoting Healthy and Safe Use of Social Media” and the chapter that addresses that theme has some helpful guidance around discussing social media during appointments. 
• The 5 Cs of Media Use, developed by the Center of Excellence, is a mnemonic that can be used to talk to parents about kids and screens. They are: Child, Content, Calm, Crowding Out, and Communication. Along with this approach, we’ve created a series of five age-based handouts to give to parents at well-child visits. Based on current research and evidence, the handouts start by informing parents about their children’s developmental stages, how this influences media use, and healthy media habits to strive for at home.  
  • The Five C s of Media Use: Example screening questions: 
  • Child: Questions focused on the individual experience. How are you feeling about your media and technology use lately? How do you feel during or after you’ve used media and technology use? Are there any particular topics or experiences in this area you’d like to talk about? 
  • Content: Questions focused on what content the child experiences. What types of content do you enjoy with your media and technology use? Have you experienced any negative or scary content lately? How did you feel about that? What sources of support did you use to navigate that situation? Have you seen any health-related content that you want to ask me about? 
  • Crowd out: Questions about whether media is displacing other activities. Do you feel like your media and technology use is crowding out any important activities lately? What are your thoughts on how to balance your online and offline time or activities? 
  • Calm: Questions about resources for calm. I know that many of my patients use media to distract or calm down. How do you use media for these purposes? What are other ways you can help calm yourself after a stressful day? 
  • Communication: Questions about communicating with parents, guardians and trusted adults. Communicating with trusted adults about your media and technology use is really important to help you feel supported. How is that going for you? Who can you talk to? How often do you and your parents/guardians communicate about media and technology use? What are ways to make those conversations helpful to you? 

The AAP Center of Excellence also has several resources for clinicians that outline balanced approaches to discussing social media with adolescent patients and their families. The Center has example case studies which model conversations between clinicians, patients, and families and provide additional resources. These case studies include examples of non-judgmental, open-ended questions that clinicians can consider asking such as “I’d like to hear from you how you gauge your own use of social media – what feels healthy and how do you recognize when it’s not the best use of your time?” and  “I’m wondering what role, if any, does social media or other digital media play in your family?” The Center also has a free recorded webinar for clinicians that outlines current research on social media and youth mental health and provides suggestions for discussing social media during medical appointments.  

Resources that clinicians can recommend to patients and families: 

Beyond screening for social media experiences, clinicians can play a key role in providing anticipatory guidance and resources to adolescents and families about social media. These include: 

• AAP’s 12 Tips to Help Children Develop Healthy Digital Habits. This tipsheet developed by the American Academy of Pediatrics outlines 12 ways families can support their teens in developing healthy digital habits. Practitioners can refer families to this tipsheet. 
• Phone Ready Questionnaire. Rather than specific ages, the questionnaire guides families and adolescents to reflect on behaviors that show whether an adolescent is ready for the responsibility of having their own phone. 
• AAP’s Family Media Plan. The FMP guides families to co-create shared expectations around media use. 
• AAP Center of Excellence’s Research-Based Tips for Families from Pediatricians. This 1-pager tipsheet, available in English and Spanish, can be provided to families as a resource:  
• AAP’s Bright Futures Tool & Resource Kit contains a chapter called “Beyond Screen Time: A Parent’s Guide to Media Use” 
  • This guide lays out digital media use guidelines for parents, families, and caregivers and is broken down by age. 

Search Engines & Databases used:  

• HAPI database (Health and Psychosocial Instruments) 
• Direct search for PRIUSS and Bright Futures resources  

References: 

• Danielle L. Clark, Jean L. Raphael, Amy L. McGuire; HEADS4: Social Media Screening in Adolescent Primary Care. Pediatrics June 2018; 141 (6): e20173655. 10.1542/peds.2017-3655 
• Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017  
• Jelenchick, L. A., Eickhoff, J., Christakis, D. A., Brown, R. L., Zhang, C., Benson, M., & Moreno, M. A. (2014). The Problematic and Risky Internet Use Screening Scale (PRIUSS) for Adolescents and Young Adults: Scale Development and Refinement. Computers in human behavior, 35, 10.1016/j.chb.2014.01.035.  
• Moreno MA, Arseniev-Koehler A, Selkie E. Development and Testing of a 3-item screening tool for Problematic Internet Use. J Pediatr. 2016 Sep; 176:167-172. 

Age: 11- 17 

Topics: Social media, screening tools, screening questions, problematic internet use, clinics, pediatrics, electronic medical record system 

Role: Clinician