Considerations for Screening in a Telehealth Environment

Just as with an in-person visit, clinicians may conduct screenings with their adolescent patients in a telehealth environment. Oftentimes, instruments can be sent to adolescents in advance of the visit via a secure patient portal. When facilitated appropriately, this can be one way to enhance confidentiality with adolescents.

Tip: The Bright Futures Previsit Questionnaire Risk Assessment and Anticipatory Guidance questions are formatted as Yes/No/Sometimes/Unsure questions. This can be administered prior to the visit as part of surveillance of adolescent/family well-being, or as part of the private component of the telehealth visit with an adolescent. Examples can be found here.

Per the Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care (Periodicity Schedule), adolescents should receive several risk assessments and screenings annually, including:

• Psychosocial/Behavioral Assessment (ages 11-21)
• Tobacco, Alcohol, or Drug Use Assessment (ages 11-21)
• Depression Screening (ages 12-21)
• Risk Assessment for Sexually Transmitted Infections (ages 11-21)

For more information about these recommendations, review the footnotes in the Periodicity Schedule. Links to commonly used screening instruments and tools related to the recommendations can be found here.

Have a Plan for When Concerns are Identified

It is important to have a plan for concerns identified via screenings and risk assessments that are administered in a telehealth environment. Consider having the workflows identified and accessible prior to the telehealth visit.

When communicating with adolescents and their families about concerns identified via screenings or risk assessments, consider the following sample language in your conversation:

• “Is it okay if we review the screening that you filled out, together?”
  • If an adolescent asks about screen sharing, consider the feasibility of using the “share screen” function during the telehealth visit.
• “Can you tell me more about how this feels?”
  • Note: When communicating with the adolescent about the screening results, use the language that the adolescent uses. If they say that they are depressed, use the word depressed. If they say that they are “bummed”, use that language.

Click here for an example interaction during which a pediatric clinician communicates with an adolescent about depression. Additional resources related to integrating mental health into pediatric practice can be found here.

Note: If administering a screening tool that assesses risk of suicide, consider administering during the visit (instead of before the visit) so that any concerns are captured in a timely manner.

The American Academy of Pediatrics (AAP) does not approve nor endorse any specific tool for screening purposes.

Bright Futures is a national health promotion and prevention initiative, led by the American Academy of Pediatrics (AAP) and supported by the Maternal and Child Health Bureau, Health Resources and Services Administration. The Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition, provides theory-based and evidence-driven guidance for all preventive care screenings and well-child visits. Bright Futures content can be incorporated into many public health programs such as home visiting, child care, school-based health clinics, and many others. Materials developed especially for families are also available. Learn more about Bright Futures and get Bright Futures materials by visiting brightfutures.aap.org.

Funding Acknowledgements

Supporting Providers and Families to Access Telehealth and Distant Care Services for Pediatric Care
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,000,000 with no percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

Bright Futures National Center
This resource is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $5,000,000 with 10 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the US Government.

For more information, please visit HRSA.gov.