title: Improvement in adolescent screening and counseling rates for risk behaviors and developmental tasks.
abstract: BACKGROUND
  High-quality preventive services for youth aged 11 to 18 include assessment and counseling regarding health behavior risks and developmental tasks/strengths of adolescence. Nationally, primary care health behavior risk screening and counseling rates lag considerably behind other preventive health services. The purpose of this project was to assist pediatric and family medicine practices to make office systems-based changes that promote comprehensive screening and counseling for risks and developmental tasks/strengths during adolescent preventive services visits.
  
  
  METHODS
  Over a 9-month period, 7 pediatric and 1 family medicine primary care practices (13 physicians and 3 nurse practitioners) participated in a modified Breakthrough Series Collaborative. This project was designed to support primary care practitioner efforts to implement comprehensive screening and counseling for risk behaviors and developmental tasks/strengths for their adolescent patients and increase the rate of brief office intervention and referral. Composite variables were designed to reflect whether screening and counseling were documented for risks and developmental tasks. Statistical comparisons were made by using the nonparametric Wilcoxon matched-pairs signed rank test.
  
  
  RESULTS
  There were increases in the composite measures of screening and counseling for risk behaviors (all 6 risks: 26%-50%, P = .01) and 3 of 4 developmental tasks/strengths (32%-66%, P = .01). Documentation of office interventions for identified risks and out-of office referral rates did not change.
  
  
  CONCLUSIONS
  With the use of an office systems-based approach, screening and counseling for all critical risk behaviors and developmental tasks/strengths during adolescent preventive services visits can be improved in primary care practices.
authors.affiliation: The Vermont Child Health Improvement Program, Department of Pediatrics, College of Medicine, University of Vermont, Burlington, Vermont 05401, USA. paula.duncan@uvm.edu
authors.forename: Paula
authors.initials: P
authors.lastname: Duncan
authors.forename: Barbara
authors.initials: B
authors.lastname: Frankowski
authors.forename: Peggy
authors.initials: P
authors.lastname: Carey
authors.forename: Emily
authors.initials: E
authors.lastname: Kallock
authors.forename: Thomas
authors.initials: T
authors.lastname: Delaney
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dixon
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia
authors.forename: Judith S
authors.initials: JS
authors.lastname: Shaw
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D041923:Adolescent Development; D016497:Adolescent Health Services / Q000592:standards*; D002648:Child; D037001:Directive Counseling; D005260:Female; D006801:Humans; D008297:Male; D058996:Quality Improvement; D012309:Risk-Taking; D013647:Task Performance and Analysis