Problem
Difficulty screening for at-risk behaviours that are linked to youth violence.
Youth violence is a growing problem in the US and contributing to absenteeism in schools. In 2017, 6.0% of high school students were threatened or injured with a weapon, such as a gun or a knife, while on school property, and missed school as a result (1). The American Academy of Pediatrics has emphasized the importance of youth violence (YV) screening during primary care visits for early intervention and referral to successful prevention strategies but it is not routinely performed. Several studies have found success with the use of pre-visit questionnaires to support physicians in discussing certain topics with adolescents, including youth violence, bullying, tobacco, and alcohol use.
In order to address this problem, researchers at Brown University Injury Prevention Center wanted to assess the impact of screening for risky and violent behaviors before a clinical visit on both the sensitivity to identify at-risk patients, as well as how it might impact in-clinic workflow and productivity. However, existing paper-based questionnaires posed several problems, including
- Impractical pre-visit delivery via mail, email, etc. over-burdening staff
- Lack of ability to integrate completed surveys into the clinical / practice workflow via manual data entry, EMR integration, etc.
- Static, uninviting design impeding response rates and fidelity of data
- Teens reluctance in sharing sensitive information on paper
Solution
Prompting discussions on youth violence with a Digitally Empathetic pre-visit questionnaire.
Brown University Injury Prevention Center uses Tickit Screener: partnering with Tickit Health, the Brown University Injury Prevention Center team conducted a study to examine the effect of adding youth violence questions in a digital pre-visit questionnaire on the Tickit® platform. The study was implemented at the clinic that sees over 8,000 patients who are ethnically, racially, and socioeconomically diverse (31% African American and 51% Hispanic).
Using Tickit Health’s Digitally Empathetic design-thinking, the questionnaire was configured based on the validated Adolescent Stress Questionnaire and HEADSSS interview approach, including four additional validated youth violence questions from the 2011 Youth Risk Behavior Survey (YRBS). The digital questionnaire was given to 183 participants via kiosk in clinic on the Tickit platform which dynamically led participants through categories of home, education, eating, emotions, activities, drugs/alcohol/tobacco use, sexual health, and safety.
View The Study
66% of adolescents who discussed YV with their doctor rated the discussion as very helpful, suggesting potential reduction in risky behaviours
Outcomes
- 2.6x increase in discussing youth violence with participants
- 66% of adolescents who discussed YV with their doctor rated the discussion as very helpful, suggesting potential reduction in risky behaviours
- 99% of youth participants said Tickit was easy to use.
- 93% of youth participants felt ready for the visit after taking the survey on Tickit.
- 97% of youth participants felt responses from survey would be likely helpful for doctors/nurses.
Conclusion
Given the limited time and resources available to primary care providers, early intervention regarding factors impacting violence in youth can be a challenge. To identify at-risk factors, clinicians require tools to help support the practice of asking sensitive questions about patient’s behaviors and social and environmental factors impacting their lives.
Using a dynamic, Digitally Empathetic tool from Tickit, adolescents reported greater comfort revealing sensitive topics to a computer than to a person, hence provided more complete and accurate information regarding health risk behaviors. Additionally, the reports and visual graphs available to the clinic staff and MDs through the Population Management Module of Tickit gave users a comprehensive picture of the patient-reported data and freed up time to focus on topics that require immediate attention, such as youth in need of violence support and prevention. Based on the results of this study, the digital pre-visit questionnaire, powered by Tickit, proved an effective and practical way of screening to be acceptable amongst adolescents.
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