You have questions? We have answers.
What is the operating system for RAAPS and ACT?
The Rapid Assessment for Adolescent Preventive Services (RAAPS) and the Adolescent Counseling Technology (ACT) modules operate on a HIPAA compliant technology platform.
Third Party Hosting:
- The software is hosted on a HIPAA compliant cloud environment at a third party hosting company with multiple data centers located in the United States.
- The environment has been audited against the OCR HIPAA protocol and provides AES 256-bit encryption that meets the NIST standard offered at the hardware level.
- The data is encrypted through every step of offsite backup and recovery locations.
- Encryption, antivirus, and patch management are standard with additional security including daily log reviews, file integrity monitoring, and vulnerability scanning by staff who receive regular HIPAA compliance and security training.
Design for Compliance:
The software and environment is designed for compliance addressing:
- Secure data transmission utilizing SSL with page level security control.
- Backup and recovery is managed by third party hosting with offsite encrypted storage.
- System level access is controlled by password protection requiring a minimum of 7 characters in a combination of numbers, letters, and special characters.
- Data storage is stored at rest with AES 256-bit level of encryption.
- Key data elements are encrypted prior to storage in the database.
Additionally, the patient portal within an organization’s database is a separately secured area of the platform, so youth interacting with the RAAPS and ACT only have access to their personalized dashboard, survey assessment pages and individualized health education.
What is RAAPS?
The Rapid Assessment for Adolescent Preventive Services (RAAPS) is a reliable and valid assessment and screening tool that identifies those risk behaviors in youth and young adults that contribute most to their morbidity and mortality, and provides simple health messages to support behavior change. Studies were completed using psychometric methods to establish face-, content-, and criterion-related validity and inter-rater and equivalence reliability for the RAAPS screening tool. A full listing of publications can be found on the Possibilities for Change website.
RAAPS tools include:
- RAAPS Age-Specific Comprehensive Risk Assessment and Support: Tailored to Older Child (9-12yrs), Adolescent (13-18yrs) and Young Adult (18-24yrs) risks.
What is ACT?
The ACT modules (sexual health and tobacco) provide comprehensive, tailored assessment and health education directing youth towards the creation of a positive behavior change plan (e.g. condom use with every sexual encounter). The ACT modules offer busy practices and professionals a virtual health educator to support the care provided to youth on specific health topics (e.g. sexual behaviors). The ACT modules facilitate and document a comprehensive assessment based on youth reported behaviors and stage of change with embedded health education tailored to the needs of individual youth. Tailoring and stage-based interventions have been shown to dramatically increase successful retention and completion of interventions, and promotes movement towards positive behavior change. The ACT modules also offer youth text message follow up to continue their engagement in positive health behaviors beyond their health care visit.
The ACT modules were developed using theories proven effective in adolescent behavior change: the Transtheoretical Model (Prochaska & DiClemente) and Motivational Interviewing (Miller & Rollnick). The content included in the individual modules for behavior assessment was developed using current literature, data sources on risk behaviors, and content expert review.
ACT modules include:
- ACT Tobacco Intervention Module Supports youth in reducing their use or progression of use of tobacco products
- ACT Sexual Health Intervention Module: Supports sexually active youth in consistent use of condoms and/or hormonal birth control methods
Frequently Asked Questions about RAAPS and ACT
Can I see the questions included in the RAAPS and ACT?
Yes, a copy of the standard RAAPS questions can be downloaded for your review. In order to download these you will be asked to provide your contact information and agree to a copyright disclaimer. Please note: the RAAPS and ACT questions may not be placed into an electronic system, or be distributed to other providers (instead, please point them directly to the Possibilities for Change website to download a copy for themselves.)
What are professionals saying about RAAPS, ACT and the BIT platform?
From schools to colleges to health care clinics, platform user responses have been overwhelmingly positive.Read more about what professionals have to say! Read more about what organizations have shared.
How does RAAPS and ACT interact with existing electronic health record (EHR) systems?
The RAAPS and ACT were developed to function as an independent electronic health record system specifically supporting effective risk screening for youth and eliminating common screening barriers. The platform designed for RAAPS and ACT differs from typical EHR systems.
For youth: Unique features of the RAAPS and ACT (absent from other EHR systems) include an engaging patient portal and dashboard; interactive, branching assessments; audio option for completion; translated text and audio; individualized health education and creation of behavior change plans.
For professionals: Features include visit summaries, evidence-based talking points, easy documentation of identified risk behaviors, annual alerts for screening, a tracking system for referrals, and clinically useful one-click reports.
Clinic staff and providers have multiple options for integrating visit notes. Integration is as easy as any of these:
- Copy and paste the assessment summary completed in RAAPS and ACT into your existing EHR visit note.
- Save the assessment summary as a pdf and upload into your existing EHR.
- Create an alert in your EHR that RAAPS or ACT was completed and leave all notes there. This is compliant with requirements for EHR storage and tracking of notes.
- Embed a link into your existing EHR to open myraaps.com. This link would be added at your organizational level and requires programming of your EHR.
Many organizations choose to leave the completed RAAPS or ACT assessments in the HIPAA compliant web-based platform to maintain greater confidentiality.
How do youth complete the RAAPS and ACT modules?
RAAPS and ACT modules can be completed on any internet enabled device including desktop and laptop computers, tablets, and smart phones. A clinic staff member enters the youth’s demographic information prior to the youth taking the assessment and assigns a username and password. When it is time to initiate the assessment, the youth would log in on the device to start.
What software is necessary when using RAAPS or ACT?
The system operating RAAPS and ACT is web-based and has been tested to be compatible with the Chrome browser, version 36 or higher and Internet Explorer version 10 or higher. Other web browsers could cause some functionality to be downgraded, limited, or available only through alternative steps. There is no program or app – RAAPS and ACT is only accessible through a web browser.
Will a positive response in RAAPS trigger the ACT modules if we are using both?
The RAAPS and ACT modules operate independently. However, the RAAPS and ACT modules may be assigned at the same time and then launched by the student one after the other in the same sitting.
Are the youth web pages mobile friendly?
Yes, the entire system (including the dashboard) will automatically adjust to any size screen – including tablets and smart phones.
Were youth involved in the development of the RAAPS and ACT modules?
Yes, Possibilities for Change is committed to a team approach. The development team includes researchers in the field of adolescent health, multi-disciplinary clinicians, national content experts, and youth/young adults. Focus groups with youth and written feedback from youth are critical pieces of our product development. This approach helps ensure that youth find the system interactive and engaging. The approach also improves youth honesty, comfort, and content comprehension as they read or listen to materials and answer sensitive questions about their behaviors
How is RAAPS different from GAPS?
GAPS, once considered the gold standard for risk screening, was developed by the American Medical Association (AMA) and is no longer supported (last updated in 1998) or available for download. RAAPS was validated against GAPS in a research study that found both tools performed at the same level in identifying behaviors contributing to adolescent and young adult morbidity and mortality. No significant differences were found between the tools. Therefore, RAAPS was determined to be as reliable as GAPS using significantly fewer questions (RAAPS 21 versus GAPS 72).
How does using RAAPS meet Patient Centered Medical Home (PCMH) standards for adolescent care?
Behavioral assessment and counseling are a vital part of the PCMH components. More information on how RAAPS meets National Committee for Quality Assurance (NCQA) key components of PCMH can be found here: PCMH
What is the reading level of the RAAPS and ACT modules?
Reading levels vary by assessment. Audio is available within the system for all questions and health education messaging. Youth may choose to listen, read, or use both methods when interacting with the system improving health literacy. Headphones are recommended.
How do youth interact with the RAAPS and ACT modules? What do they see?
The assessment questions either require a simple yes/no response or have multiple choice options. Youth must answer each question in order to advance to the next and complete the assessment. Images relevant to the assessment content appear with each question. Question font, color and response buttons were developed to engage youth. At certain points in the ACT modules, youth will be presented with health education that directly relates to their previous responses. Relevant images will also accompany this information.
Will images vary by the demographics of the respondents?
We have applied for funding to tailor images within the ACT modules based on sex/gender, race/ethnicity, sexual orientation, and pregnant or parenting youth. This upgrade to the system is in process.
How can I use data generated from my reports to improve the care provided to our adolescent population?
Using a assessment to track behaviors and risk reduction can assist professionals in monitoring risk and behavior change over time, similar to the monitoring of weight or blood pressure. Early risk identification can assist in tailoring specific preventive education counseling and intervention programs that are geared to meet the specific needs of each youth population. For example, if rates of nutritional deficiency, sexual activity or depression are particularly elevated in a select population, then special attention could be directed to these issues by developing standards of care, offering group education programs, or placing appropriate health education materials in waiting and exam rooms.
Implementing RAAPS and ACT into your workflow
How long will it take for youth to complete the RAAPS and ACT modules?
- The RAAPS assessment contains 21 questions and takes approximately five (5) minutes to complete.
- The ACT modules take approximately ten (10) minutes to complete. The number of questions presented vary according to a youth’s stage of behavior change and responses. Therefore, the time to complete these modules will vary.
Do youth provide consent before utilizing the RAAPS and ACT modules?
Yes! There is a confidentiality statement youth will agree to before advancing to the assessment questions and health education. If the youth doesn’t agree to the statement, the assessment will appear as declined for the clinician and the youth will not see any of the questions.
Confidentiality and minor consent should be briefly discussed with the youth, along with parameters of when information might be shared (e.g. disclosures of self-harm or abuse). Reason for the assessment should also be shared (e.g. We care about your health and want to get to know you better so that we understand what you might need to stay healthy.) This can be done by professionals administering school wide screening, or by the medical assistant or support staff in a practice as they set up the youth to start the assessment as part of the check-in process.
What are some typical workflows for RAAPS or ACT module completion?
Workflows vary and should be created to ensure both youth confidentiality and ease for the setting. In a practice setting, assessments could be completed as youth wait to be seen by their healthcare provider. This can be done:
- in a private area of the waiting room.
- in the exam room as youth are waiting for their healthcare provider to come in.
- in the triage area while they are getting height/weight/blood pressure screening.
It is important that parents and siblings or other peers are separated from youth as they are completing the assessment. School-wide assessments are typically completed as a class rotation through a computer lab or by using tablets within classrooms. In order for youth to complete the assessments honestly, an environment of safety and trust must be established.
Are there procedural and structural changes that would make implementation easier?
- Identify provider champions in implementation sites to promote change in work flow and processes, ensuring smoother implementation.
- Consider patient wait times and ways that wait times may be used for youth to complete the assessment.
- Have patient advocates/office nurses (if available) ensure assessment is being completed during check-in.
- Create appropriate space for privacy while completing the assessment.
- Consider moving the completion of the assessment out of the health center – for example when a youth is identified as sexually active during a visit, send them a link to complete the ACT assessment and schedule a follow up appointment to discuss.
- It takes effort and thought to incorporate the RAAPS or ACT assessments into existing workflows, but once this happens, providers report that using the assessments saves time during the visit and gives them information about their patients that they never would have known.
How can we create an appropriate space at our site in which youth will have privacy while completing the assessment?
- Partition a separate area in the waiting room.
- Bring the youth to the exam room without the parent so they may complete the assessment in the room while waiting for the provider to come in.
- Complete the assessment in the triage area (when obtaining vital signs) without the parent.
How do I effectively respond to the risk behaviors that teens have shared with me?
RAAPS and ACT are screening tools. Protocols for risk intervention and referral should be established prior to implementation. For professionals, health messages will populate based on the risky behaviors self-identified by individual youth. These health messages can be used as a resource or starting point when providing risk reduction counseling and printed for youth as individualized health education material. The content is evidence based and includes teen friendly ideas for changing behaviors and self-efficacy messages. Click here for more information on training opportunities to improve your skills in motivating adolescents to change their risky behaviors.
Billing/Reimbursement when using the RAAPS and ACT Assessments
Can RAAPS or ACT assessments be billed as an additional part of a primary care visit?
CPT Code 96127 Brief Behavioral Assessment may be used when including RAAPS or ACT screening within a healthcare visit: Brief emotional / behavioral assessment, with scoring and documentation, per standardized instrument. This code was created in response to the Affordable Care Act’s federal mandate to include mental health services as part of the essential benefits that must be included in all insurance plans offered in individual and small group markets. The mandate covers services such as depression screening for adults and adolescents, alcohol misuse in adults, alcohol and drug use in adolescents, and behavioral assessments in children and adolescents.
When I use the ACT Tobacco module, how can it be billed?
The ACT modules provide technology based assessment and counseling based on a particular behavior. When you review the visit summary and behavior change plan and provide follow up counseling, you may bill for this time as described in the following codes:
- 99406: tobacco cessation counseling 3-10min
- 99407: tobacco cessation counseling >10min
When I use the ACT Sexual Health module, how can it be billed?
The ACT modules provide technology based assessment and counseling based on a particular behavior. You may report face-to-face, individual high intensity behavioral counseling to prevent sexually transmitted infections by promoting sexual risk reduction and/or risk avoidance. This includes education, skills training, and guidance on how to change sexual behavior. You may bill for this level of counseling as described in the following code: GO445: high intensity behavioral counseling