Opportunistic adolescent health assessment in the child protection unit

© 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)Aim: Adolescent health assessments are recommended to identify health-risk behaviours. Adolescents who experience maltreatment are more likely to engage in such behaviours. This study (i) describes the frequency of health-risk behaviours amongst adolescents attending a hospital-based child protection unit (CPU) and (ii) determines whether use of a health assessment questionnaire increases the identification of these behaviours. Methods: A retrospective audit was performed of case notes of adolescents (aged ≥ 12 years) presenting to the CPU over 5 years (2007–2011). Data regarding health-risk behaviours were extracted. In 2012, following the introduction of a standardised HEADSS-based four-page questionnaire, health-risk data were collected prospectively over 18 months. The proportion of subjects reporting health-risk behaviours, before and after questionnaire introduction, was analysed. Results: Two hundred fifty-eight subjects, median age 13 (range 12–18) years, 78% female, were included in the pre-questionnaire period; and 85 subjects, median age 14 (range 12–17) years, 86% female, were included following introduction of the questionnaire. Questionnaire use was associated with an increase in the frequency of health-risk behaviours identified in the following domains: Education (odds ratio 4.48 [confidence interval 2.56–7.96] P <0.001), Activities (16.18 [6.70–42.74] P <0.001), Drugs/alcohol (4.00 [2.23–7.16] P <0.001) and Suicidality (8.27 [4.59–14.92] P <0.001). Participants reported higher rates of health-risk behaviours than the national population. Conclusion: Adolescents attending a hospital-based CPU report high rates of health-risk behaviours. A standardised questionnaire results in increased identification of such behaviours.