Author: Jennifer Salerno

Why Asking Teens the Right Questions Matters

Nearly half of all youth who commit suicide visited a healthcare provider within the previous month. Mental health risks (depression, anger management, being bullied, having thoughts of suicide or self-harm) now rank higher than drug, alcohol and tobacco use among youth. With more than 8000 completed RAAPS screenings, Triangle Pediatrics, a National Committee for Quality Assurance (NCQA) recognized, patient-centered medical home in Cary, NC, knows just how important it is to ask the right questions when it comes to serving their adolescent patients.

There are a lot of things in a physical or well visit you might have to talk about.  RAAPS gives the doctors a starting point of what’s important for each teen; it helps them tailor and focus the visit to use their time with the patient more effectively.  It has been successful in identifying really important risks and in learning things we wouldn’t have before. We’ve been screening with RAAPS for so many years now that it’s become the new normal; it just ‘is.’ And the doctors really appreciate having all of the questions – and more truthful answers,” shared Cyndi Kirchhoff, RN, Triage Manager.

How it Looks in Practice

An effective workflow can drive adoption and enable sustainable utilization over time.  So how exactly does Triangle Pediatrics complete so many RAAPS?

  1. Right now we have two computer kiosks set up, off to the side in a private area away from the waiting room,” explained Cyndi. “The day before an appointment, as part of their daily activities, the front-desk staff log into RAAPS and sets up any patients over the age of 13 who have a well-visit scheduled the next day.
  2. When the teen checks in, the front staff asks the parent to have a seat in the waiting room and takes the teen to a station and logs them in. Once RAAPS is complete the teens are logged out and they return to the waiting area.
  3. The physician previews the results. Then once they are in the room one-on-one with the patient, they go over the positive responses and capture any comments in the RAAPS system. A PDF of the survey results and clinician notes are pulled electronically into the practice EMR after the appointment.”

The Results?

RAAPS reports reveal impressive outcomes across Triangle Pediatrics with this approach.  Results of youth patients seen two years in a row, who identified risks and received physician counseling and referrals when needed, revealed a reduction in one year’s time in all identified risks.  Most notably there has been a significant reduction in risks related to mental health issues.

Check out the full case study to learn more about Triangle Pediatrics’ success. Give youth the means to disclose risk before it is too late and get started screening with RAAPS at your organization, contact us today at info@pos4chg.org.

Combatting the Teen Vaping “Evil”

“It was an evil that I hadn’t faced before,” said Dr. Hassan Nemeh, the surgical director of Thoracic Organ Transplant at Henry Ford Hospital in Detroit. In coverage by The Detroit News, after Dr. Nemeh transplanted two lungs into a teenage boy who was going to die from vaping, he added that the inflammation and scarring in the 17-year-old’s lungs were “nothing that I have ever seen” across 20 years of similar surgeries.

E-cigarettes have been tied to 42 fatalities and more than 2,000 lung injuries in the U.S., according to the CDC, and youth use has continued to rise despite federal law that prohibits sales to those under 18—regulations and bans are not enough.

ACT now to combat this crisis:

  • Thorough Assessment of Risks & Behaviors to identify youth who are vaping, what triggers their nicotine usage (peer influence, stress, addiction) and what might motivate them to make a change.
  • Evidence-based, Tailored Risk Coaching & Action Plan to support reduction and cessation in youth.
  • Continued Engagement to help youth stay on track. Facing vape culture in school can be just as difficult—if not more difficult—than quitting an addiction to nicotine, so youth need continued support beyond a one-time intervention.

But how can you deliver all of this in a way that still fits the workflow of your school, organization or clinic? Answer: Adolescent Counseling Technology for Nicotine & Tobacco (ACT-NT). ACT-NT is an interactive, evidence-based assessment and counseling system designed for the unique needs of youth using nicotine products – including vaping, cigarettes, and smokeless tobacco. The secure, web-based ACT-NT program is designed to be delivered in both clinical and non-clinical settings (e.g., in schools, physician offices, or youth-serving organizations) and includes all three critical components listed above delivered by technology.

Developed in part with funding from the National Institutes of Health (NIH), and incorporating guidelines from the Centers for Disease Control and Prevention, ACT-NT was created to provide an engaging, web-based platform designed uniquely for youth, while ensuring quality, evidence-based cessation coaching that works with professionals—as a stand-alone tool or with professional discussion—optimizing their time to properly address nicotine and tobacco risk. Using science-based communication techniques proven to be most effective in adolescent behavior change, the ACT-NT technology identifies which nicotine products a youth is using, how often and why.

But does it work? Yes!

ACT-NT data shows that among youth reporting vaping and that used ACT-NT there was a:

  • 34% decrease in the use of nicotine products after 1 month
  • 44% reduction after 3 months AND
  • 50% of youth took steps to reduce or quit using

Interested in learning more about how ACT-NT can help you reduce youth vaping?

Check out the recording of our recent webinar, Taking ACTion on Teen Vaping, or contact us today!

Bullying Uncovered: Supporting Youth Most at Risk

October is National Bullying Prevention Month. Bullying can impact a youth’s education, physical and emotional health, and their safety and well-being. Annual RAAPS* data consistently identifies bullying in the top youth risks—and of those reporting being bullied in the last year, 67% also flagged positively for depression (2 out of 3 youth being bullied) and 33% for suicide/self-harm (1 out of 3 youth being bullied), nearly 4x higher than the overall population.

Youth experiencing bullying are at highest risk for other serious mental health struggles, yet many times are flying under the radar of professionals and parents. Risk screening is one of the most effective ways you can help identify and support youth in need! Schools have a unique opportunity through school-wide screening, ensuring at-risk students receive appropriate intervention and referral care, while providing population-level data collection to help direct programming.

One of the most alarming things we found is that across the board 30% of our students are flagging positive for depression,” shared Sandy Rowe, Executive Director of the Pender Alliance for Teen Health (PATH). “One of the guidance counselors spoke to a girl who had flagged for suicidal ideation and was referred for follow-up counseling. She shared she had a plan and thought about it every day. The guidance counselor had been working with this young girl for a long time and she had never said anything about suicide before. When the counselor inquired as to why, the girl responded: ‘No one ever asked me the question.’

I knew then we were on the right track. This girl was under the radar. Nobody knew she was thinking about it – no one with the capacity to help her (her parents or her guidance counselor) knew she was at risk. And she was not an isolated incident, of the over 4000 kids we surveyed – 440 flagged for suicidal ideation.

It was a little dire to find out what these kids are living with every day – they are just trying to go to school, yet they have this heavy burden—it was so important that we did this. Having this data will help drive all of our work going forward.

Barriers & Best Practices

School-wide screening is not without its challenges. We asked Sandy about what she learned along the way and what she would recommend to others.

  1. Start with the 3P’s: Planning, Processes & ProtocolsIn some schools we had 60 kids that needed follow up, in other schools we had 30 – it all depended on the size of school. The protocols we put in place fostered a collaborative, confidential approach that ensured we were able to gather the population-level data we needed and still meet quickly with each student at highest risk.
  2. Find your Champions & AdvocatesWe were very lucky. We had a lot of very supportive program champions – the Superintendent of Schools, the Director of Special Students, and the principals were all very supportive of the program. Of course, some staff can be a little territorial – it’s natural that they have their own way of doing things. School by school, every time, I spoke to the guidance counselor groups prior to the survey being given at their school. I explained that we knew this was asking a lot, that we weren’t trying to increase their workload but instead provide tools and resources to support them. Finding the right champions depends on your demographics. If you have school nurses, they are on the front line, they get it. But not all students use a school nurse. If you have active parents, go to PTA meetings to engage parent advocates.
  3. Spread the Word – and Keep it Positive!It’s important to do upfront education and help control the narrative. That way the first time parents hear about the project it’s in a positive light. We are in a very conservative area of the country. It’s very rural and parents (and staff) can be skeptical. I sent out three touch points to parents before the screenings – a phone call from the principal, an email from the district, and an “opt-out” letter sent home with the students – and in it I decided to share my personal cell phone. I wanted to be proactive and help them understand the immense benefits.

Learn more about how PATH implemented RAAPS screening county-wide in this new case study: Implementing School-Wide Screening Across an Entire County: Gaining Insight & Enabling Intervention in Pender County North Carolina

*RAAPS is a validated risk screening & coaching system developed to help professionals address the risk behaviors impacting health, well-being, and academic success in 9-24 year-old youth. RAAPS tools are tailored to age and screen for exposure to social risk factors (e.g. violence, abuse, and bullying), psychosocial responses to stressors (e.g. depression and anger), and risk behaviors (e.g. suicide ideation or attempts, alcohol and substance abuse, and sexual activity).

Helping Parents Prepare for the School Year

Summer is winding down and youth will soon be stepping into another school year of new experiences, personal and academic growth, new friends, new classes—and a whole new slew of challenges. Whether you interact with youth in a school setting, a community-based organization or as a clinician, chances are you can offer much-needed support for parents during this time of transition, too.

Fostering a trusting, two-way relationship with open lines of communication is one of the key factors for ensuring youth will have a successful school year. Why? If youth feel like they are seen and heard by a trusted adult, they will be more likely to come to them when common, yet challenging scenarios present themselves—like peer pressure, romantic relationships, gossip, academic pressure and stress. Strengthening the family unit is key for building protective factors in the home and community.

Here are a few tips from our Teen Speak® series you can offer parents to help them navigate the school year with confidence, poise and understanding:

  1. Show empathy. Things are a bit different for today’s teenagers. You may be a tad out of step with what it’s like to be constantly connected to your peers and have your life constantly broadcasted on social media. Admit that it’s never easy being a teenager.
  2. Talk with, not at your teen. When discussing the upcoming school year, talk with your teen, not at It makes a big difference! Instead of telling them what you want, include your child in a discussion about bedtime routines, morning routines, academic goals, and new social pressures. Many teens are stressed about the big transition. Moving up a grade means facing more academic demands, a new teacher, and a changing social circle. It can be helpful to sit down and talk with your teen about successes from last year and about your expectations for them during the upcoming school. Listening to your teen and having a two-way conversation supports independence and decision-making skills.
  3. Foster self-worth and self-esteem. It’s no secret that teens live up or down to our expectations. Teens whose strengths are recognized will be motivated to develop those strengths. Teens who are always told something is wrong with them will wilt, and are more likely to use substances, report depression and anxiety, and have sex at an early age. Empower your teen to take care of and value themselves.
  4. Ask open-ended questions. As easy it is to lecture, it doesn’t lead to a productive and honest two-way discussion. Open-ended questions allow teens to think through behaviors and possible alternatives to those behaviors. Put simply: open-ended questions are not easily answered with a yes or no response. If you’d like to have a conversation with your teen about time management, you could say, “How will you handle juggling your social life, school work and sports commitments?”  instead of “Are you OK with all the commitments you have this year?”
  5. Remember that teen behaviors are normal. The biggest thing to remember when you are frustrated with how your child is behaving is that they have no control over the changes happening in their bodies. They are riding a roller-coaster of highs and lows. Think about what it is like to go through menopause and middle age (or what you’ve heard about it), multiply that by 100 and put yourself in an environment where all your friends and co-workers are going through the same thing. Sounds horrible, right? This is what teens are dealing with every day.

Returning to school is a big change after settling into a summer routine. As we head into the new school year, we’d like to offer additional help by providing a new parent resource. Building Strong Connections with Your Teen offers tips for parents to help strengthen relationships and navigate tough conversations. You can use this resource as a parent handout in your office or organization and distribute to parents at the start of school year. This handout also acts as an introduction to our popular Teen Speak® series, which provides communication strategies to help parents connect with their teens and create cohesive family units.

Let’s Get Visual: Presenting RAAPS Data

Whether you’re in a SBHC, primary care office, or other youth serving organization, you know the importance of data and reporting but…

Did You Know: Tracking risky behaviors at the population level is the most direct and valuable way to support youth.

The thousands of professionals that have integrated RAAPS into their workflow have found that quality of care has substantially improved with the help of real-time data and reporting.

 “The RAAPS assessments gave us a better understanding of how to help our students because we had a full view of the issues impacting them, not just the issues we were traditionally accustomed to identifying. It’s one thing to have an assumption; it’s another thing to have actual data—that makes it clearer.”

RAAPS innovative technology collects data to help answer:

  • What are the greatest risks in my youth population?
  • Are we seeing improvements in risks over time after screening and coaching?
  • How are we meeting current quality measures?
  • What does the population data show that could be used to direct services and programming?
  • What risk factor disparities exist in my youth population?

But once you have your data, how do you present it in a way that’s digestible to everyone who needs to see it? A visual representation in the form of an infographic may be your answer!

An infographic can provide a snapshot of your work—highlighting risk factors youth are experiencing and how they change over time, vary by demographics, etc.—which allows you to communicate information quickly and easily, engage audiences, identify trends, and showcase programming that is important to your organization or community.

To get started, we’ve created the RAAPS Reporting Infographic Template. This new resource helps you to visually present your organization’s data in an accessible and customizable way. (You can learn more in the recording of our recent webinar.) Here’s a look at just one of the available pages, populated with the 2018 RAAPS overall data:

RAAPS Reporting Infographic - P4C 2018 - pg 1

The RAAPS suite of reports provides many options for exploring your data, and the examples in the template are just a starting place. For instance, maybe you’re interested in the relationship between bullying and self-harm, or you want to look at the relationship between unprotected sex and other risk factors. This is a chance to learn trends and better understand relationships between risks.

A detailed Reference Guide and Training Video outlining the process of populating the RAAPS Reporting Infographic with your organization’s data is available to customers on the P4C Login Training & Support page under the RAAPS Reporting Infographic Heading. To access the Training & Support page, click the green Help button on your P4C Login blue menu panel.