While no standard framework yet exists, the brief suggests nine common components drawn from models used with children ages 0-5 in pediatric and family medicine, adapted to guide behavioral-developmental health screening and response for adolescents. 

• Trauma-informed approach: Providing psychoeducation in a non-judgmental, trauma-informed manner, acknowledging feelings, offering validation and support, and collaborating on a care plan that empowers patients and families.  

• Two-generation approach: Maintaining confidentiality and respecting autonomy by considering the adolescent’s perspective and opinions, while simultaneously supporting caregiver health and parenting skills.  

• Provider/staff training: Offering up-training to help staff provide anticipatory guidance, administer validated, trauma-informed screening tools, conduct brief interventions, connect to community resources, or use data for quality improvement. 

• Anticipatory guidance: Providing age-appropriate guidance on topics such as resiliency, emotional regulation, stress management, coping skills, communication, conflict resolution, and decision-making. 

• Parent/caregiver education: Providing education and resources on adolescent development, communication, and mental health, and emphasizing safe, stable, nurturing relationships at home. 

• Team-based care: Employing integrated behavioral health clinicians, facilitating warm hand-offs, and coordinating with school-based health centers (SBHCs) and other behavioral health resources to provide accessible, low-barrier care.  

• Standard workflows for screening and response: Conducting standardized, validated screenings for trauma, stressors, behavioral health issues, and health-related social needs in the context of cumulative adversity, and developing workflows for providing appropriate interventions. 

• Connection to community resources: Establishing partnerships and referral pathways to SBHCs, mental health and substance use treatment, and social services, offering care coordination and navigation, and following up with families to ensure they access the resources. 

• Data utilization: Designing data reports to track the rates of screening, identified risks, and interventions provided, and using this information to establish data-driven quality assurance and improvement initiatives, while adhering to state health information sharing and blocking regulations relevant to adolescent healthcare. 

Implementation of these components can be tailored to fit available resources, staff expertise, and organizational goals. The brief provides real-world examples and reviews the evidence on the efficacy of a screening and referral approach. It also offers six practical steps for practices getting started: 

1. Get prepared by considering such things as how to reduce barriers to care for adolescents and the state and federal laws regarding adolescent autonomy and confidentiality;  

2. Redesign the care team to include new roles, such as care coordinators and behavioral health clinicians, and develop partnerships with school-based health centers; 

3. Conduct training and education on foundational topics like trauma-informed care approaches and adolescent brain development;  

4. Adopt validated screening tools, like the PQH-9 for depression and GAD-7 for anxiety, and establish standardized workflows to support administration, follow-up, and learning from these assessments;  

5. Identify community resources that can help patients overcome barriers to care, like transportation to appointments; and 

6. Align the electronic health record system to support workflows by developing registries and reports that ensure comprehensive screening and follow-up. 

For more details on implementing this approach into your practice, refer to the full brief. 

Photo by Eneida Hoti on Unsplash