Development, validation, and utility of internet-based, behavioral health screen for adolescents.
OBJECTIVE
The goals were to develop and to validate the Internet-based, Behavioral Health Screen (BHS) for adolescents and young adults in primary care.


METHODS
Items assessing risk behaviors and psychiatric symptoms were built into a Internet-based platform with broad functionality. Practicality and acceptability were examined with 24 patients. For psychometric validation, 415 adolescents completed the BHS and well-established rating scales. Participants recruited from primary care waiting rooms were 12 to 21 years of age (mean: 15.8 years); 66.5% were female and 77.5% black.


RESULTS
The BHS screens in 13 domains by using 54 required items and 39 follow-up items. The administration time was 8 to 15 minutes (mean: 12.4 minutes). The scales are unidimensional, are internally consistent (Cronbach's alpha = 0.75-0.87), and discriminate among adolescents with a range of diagnostic syndromes. Sensitivity and specificity were high, with overall accuracy ranging from 78% to 85%. Patients with scores above scale cutoff values for depression, suicide risk, anxiety, and posttraumatic stress disorder symptoms were > or =4 times more likely to endorse other risk behaviors or stressors.


CONCLUSIONS
The BHS addresses practical and clinical barriers to behavioral health screening in primary care. It is a brief but comprehensive, self-report, biopsychosocial assessment. The psychiatric scales are valid and predictive of risk behaviors, which facilitates exclusion of false-positive results, as well as assessment and triage.
Diamond
Guy
G
Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. diamondg@email.chop.edu
Levy
Suzanne
S
Bevans
Katherine B
KB
Fein
Joel A
JA
Wintersteen
Matthew B
MB
Tien
Allen
A
Creed
Torrey
T
D000293:Adolescent; D000294:Adolescent Behavior; D003936:Diagnosis, Computer-Assisted / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D020407:Internet / Q000458:organization & administration*; D008297:Male; D008403:Mass Screening / Q000379:methods; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011320:Primary Health Care / Q000379:methods; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012680:Sensitivity and Specificity; D014481:United States; D055815:Young Adult