Welcome to the training on Interpersonal Youth Violence provided by Texas Health and Human Services (HHS) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and other health-care professionals to recognize the manifestations and impact of interpersonal youth violence and employ best practices for screening, counseling, and prevention.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Describe manifestations and consequences of violence, including bullying, dating violence, sexting, self-injury and suicide.
- Apply screening, individualized counseling, and prevention strategies that are recommended for use in primary care.
- Evaluate a health-care provider’s ethical responsibility to respond to an adolescent patient who is a perpetrator or victim of interpersonal violence.
Please note this module expires on 6/21/2021.
This module was released on 6/21/2018.
Continuing Medical Education (Ethics Accredited)
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This course has been designated by The Texas Department of State Health Services, Continuing Education Service for 1.50 credit(s) of education in medical ethics and/or professional responsibility.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Nursing Education.
Social Workers (Ethics Accredited)
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Social Work Education.
This course has been designated by The Texas Department of State Health Services for 1.50 contact hours of education in professional ethics and social work values.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.50 total entry-level Category I contact education contact hours.
Licensed Marriage and Family Therapists (Ethics Accredited)
The Texas Department of State Health Services, Continuing Education Service is an approved provider (#466) by the Texas State Board of Examiners of Marriage and Family Therapists to offer continuing education contact hours to Licensed Marriage and Family Therapists. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) for Licensed Marriage and Family Therapists and 1.50 contact hour(s) in professional ethics for Licensed Marriage and Family Therapists.
Licensed Professional Counselors (Ethics Accredited)
The Texas Department of State Health Services, Continuing Education Service is an approved provider (#690) by the Texas State Board of Examiners of Professional Counselors to offer continuing education contact hours to Licensed Professional Counselors. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) for Licensed Professional Counselors and 1.50 contact hour(s) in professional ethics for Licensed Professional Counselors.
Licensed Chemical Dependency Counselors (Ethics Accredited)
The Texas Department of State Health Services is an approved provider (TCBAP# 0090-87E) with the Texas Certification Board for Addiction Professionals to offer continuing education contact hours to Licensed Chemical Dependency Counselors. The Texas Department of State Health Services, per approval of Division for Mental Helath and Substance Abuse, has awarded 1.50 contact hour(s) for Licensed Chemical Dependency Counselors and 1.50 credit hour(s) in professional ethics for Licensed Chemical Dependency Counselors.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Adolescent mental health screenings, free questionnaires:
- Pediatric Symptom Checklists (PSC-17, PSC-35, Y-PSC)—(For ages 4 through 18). Part of the AAP’s Bright Futures Tool and Resource Kit. PSC checklists are psychosocial screens designed to help recognize cognitive, emotional, and behavioral problems so appropriate interventions can begin as early as possible. Includes parent-completed and youth self-report versions. (Youth self-report version, Y-PSC, for ages 11 through 18 years).
- Ages and Stages Questionnaires. Social-Emotional, second edition. (ASQ-SE-2). (For first 6 years of life.)
- Aggression: MOAS (Overt Aggression Scale-Modified).
- Anxiety: the Screen for Child Anxiety Related Emotional Disorders (SCARED) Child Version and Parent Version.
- Attention-Deficit/Hyperactivity Disorder: Vanderbilt Rating Scale.
- Depression: the Mood and Feeling Questionnaire and the Parent Health Questionnaire-9, Modified for Teens (PHQ9-M)
- Eating disorders: EAT-26.
- HEEADSSS 3.0 psychosocial screening tool
- Mania: the Child Mania Rating Scale (CMRS) Parent Version.
- Obsessive-compulsive disorder: the Yale-Brown OCD Scale (YBOCS).
- Substance use: The CRAFFT 2.0 Screening Tool.
American Academy of Pediatrics. Family Media Use Plan tool.
American Academy of Pediatrics. Connected Kids.
American Academy of Pediatrics, A Guide to Safety Counseling in Office Practice.
American Academy of Pediatrics, Bright Futures. Adolescence Core Tools: Bright Futures Previsit Questionnaires.
American Academy of Pediatrics. Resilience Project.
Centers for Disease Control and Prevention. (2016). A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors.
Centers for Disease Control and Prevention. (2015). Sexually Transmitted Diseases Treatment Guidelines.
Centers for Disease Control and Prevention, Understanding School Violence fact sheet.
Centers for Disease Control and Prevention, WISQARS (Web-based Injury Statistics Query and Reporting System), an interactive, online database that provides data about fatal and nonfatal injury, violent death, and cost of injury in the United States.
Cornell Research Program on Self-Injury and Recovery. Providers may download a helpful self-injury handout for parents.
CyberWise. 6 Teen ‘Hookup’ Apps Parents Should Know About.
Human Trafficking Fact Sheets from the U.S. Department of Health and Human Services, Office of the Administration for Children and Families.
Start Strong. tips and checklists for adult influencers.
Sexual Activity and Sexual Health: Resources for Providers:
Providers can access numerous resources and publications to help them talk with patients about sexual activity and sexual health.
- The Association of Reproductive Health Professionals (ARHP) offers several provider and patient education resources, including interactive tools. Its Curricula Organizer for Reproductive Health Education (CORE) is a free collection of peer-reviewed, evidence-based teaching materials.
- Guidelines for Adolescent Health Care, published by the American College of Obstetrics and Gynecology (ACOG), is available from the ACOG website.
- Youth Friendly Services: A Manual for Service Providers to develop skills in providing quality sexual and reproductive health services to youth.
- Physicians for Reproductive Health is a clearinghouse for provider-to-provider education about best practices for adolescent reproductive and sexual health.
- The Provider’s Toolkit from the CDC gives practical advice on communicating effectively with teens on important issues, such as how to take their sexual history.
- The National Center for Victims of Crime has compiled a collection of resources for teens and other resources that may be useful.
Sexual behavior resources for parents:
- IWannaKnow.org: Information on sexual health for teens and young adults, including a Parents section with the topic, “Be an Askable Parent.”
- BoyfriendsWeb.com: Documentary on teen relationships with support materials for parents and teens.
- AdvocatesForYouth.org: Encourages responsible decisions about reproductive and sexual health, with information for parents, teens, educators, physicians, and advocates.
- loveisrespect.org: Information and resources to help children prevent abuse and get help for interpersonal relationship violence.
- pflag.org: Uniting people who are lesbian, gay, bisexual, transgender, and queer (LGBTQ) with families, friends, and allies.
That’s Not Cool is a national public education campaign
Stopbullying.gov. Download guidelines for parents about preventing cyberbullying.
Suicide resources and best practices:
Texas Health Steps, Child Health Clinical Record Forms.
Texas Department of State Health Services, Local Mental Health Authorities for referral assistance. To find mental health services in your area, please refer to the listing at http://www.dshs.state.tx.us/mhsa/lmha-list/ or search for the referral line phone number of your Local Mental Health Authority (LMHA) using the online mental health services search form. You may call the referral line of the LMHA in your area for confidential help 24 hours a day, seven days a week.
Texas Education Code Chapter 37, Section 37.001 requires independent school districts to develop and maintain anti-bullying policies that are appropriate for students at each grade level.
Texas Education Code Chapter 25, Section 25.0342 guarantees parents the opportunity to transfer a child to a different campus if the school determines that the child has been bullied at school.
Texas Association of School Boards provides resources to address the legal requirements and procedures to consider when identifying and responding to bullying in public schools.
Texas Suicide Prevention Council. (2014). Texas State Plan for Suicide Prevention.
The Rapid Assessment for Adolescent Preventive Services (RAAPS), standardized validated risk assessments filled out online by older children and adolescents.
- Alexander, S. C., Fortenberry, J. D., Pollak, K. I., Bravender, T., Davis, J. K., Ostbye, T., . . . Shields, C. G. (2014). Sexuality talk during adolescent health maintenance visits. JAMA Pediatrics, 168(2): 163-169.
- American Academy of Child and Adolescent Psychiatry. (2017). Facts for Families: Teen Suicide.
- American Academy of Child and Adolescent Psychiatry. (2013). Facts for Families: Self Injury in Adolescents.
- American Academy of Child and Adolescent Psychiatry. (2011). Prevention of Bullying Related Morbidity and Mortality Policy Statement.
- American Academy of Pediatrics. (2017). Policy Statement: Global Human Trafficking and Child Victimization. Pediatrics, Nov 2017, e20173138.
- American Academy of Pediatrics. (2016). Media Use in School-Aged Children and Adolescents. Pediatrics, Oct. 2016, e20162592.
- American Academy of Pediatrics. (2016). Media and Young Minds. Pediatrics, Oct 2016, e20162591.
- American Academy of Pediatrics. (2015). Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims. Pediatrics, 135(3): 566-574.
- American Academy of Pediatrics, Committee on Adolescence and Society for Adolescent Health and Medicine. (2014). Screening for Nonviral Sexually Transmitted Infections in Adolescents and Young Adults. Pediatrics, 134(1): e302-3311.
- American Academy of Pediatrics. (2014). Policy Statement: 2014 Recommendations for Pediatric Health Care. Pediatrics, 133(3):S68-S70.
- American Academy of Pediatrics. (2013). Children, Adolescents, and the Media. Pediatrics, 132(5):958-961.
- American Academy of Pediatrics. (2009). Policy Statement – Role of the Pediatrician in Youth Violence Prevention. Pediatrics, 103(1):173-181.
- American Academy of Pediatrics. (2008). Achieving Quality Health Services for Adolescents. Pediatrics, 132(1):e281.
- American Academy of Pediatrics. Connected Kids.
- American Academy of Pediatrics. Injury Prevention Program’s A Guide to Safety Counseling in Office Practice.
- American Association of Suicidology.
- Attorney General of Texas. (n.d.). We Are Not For Sale: Human Trafficking.
- Bennett, G. H., Shiels, W. E., II, Young, A. S., Lofthouse, N., & Mihalov, L. (2011). Self-embedding behavior: A new primary care challenge. Pediatrics, 127(6):2010-2877.
- Boyse, K. (2012). Sibling Abuse. University of Michigan Health System.
- Centers for Disease Control and Prevention. (2016). Understanding Teen Dating Violence: Fact Sheet.
- Centers for Disease Control and Prevention. (2016). HIV Among U.S. Youth, 2016.
- Centers for Disease Control and Prevention (2016) LGBT Youth
- Centers for Disease Control and Prevention. (2016). Understanding Bullying: Fact Sheet 2016.
- Centers for Disease Control and Prevention. (2016). Youth Violence Facts at a Glance.
- Centers for Disease Control and Prevention. (2016). Understanding School Violence Fact Sheet.
- Centers for Disease Control and Prevention. (2016). A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors.
- Centers for Disease Control and Prevention. (2015). 2015 STD Treatment Guidelines.
- Centers for Disease Control and Prevention. (2013). The 2013 Texas Youth Risk Behavior Surveillance System Survey (YRBSS) Data.
- Centers for Disease Control and Prevention. (2011). Grand Rounds: Chlamydia Prevention: Challenges and Strategies for Reducing Disease Burden and Sequelae.
- Centers for Disease Control and Prevention. (2006). Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings.
- Children at Risk. Human Trafficking.
- CyberWise. 6 Teen ‘Hookup’ Apps Parents Should Know About.
- David’s Legacy Foundation. (2017). SB179, David’s L12/19/17aw fact sheet.
- Derouin, A., & Bravender, T. (2004). Living on the edge: The current phenomenon of self-mutilation in adolescents [Abstract]. The American Journal of Maternal/Child Nursing, 29(1):12–18.
- Dovydaitis, T. (2010). Human Trafficking: The Role of the Health Care Provider. Journal of Midwifery and Women’s Health, 55(5):462-467.
- Eisenberg, M. E., & Aalsma, M. C. (2005). Bullying and Peer Victimization: Position Paper of the Society of Adolescent Medicine. Journal of Adolescent Health, 36(1):88-91.
- Englander, E., Donnerstein, E., Kowalaki, R., Lin, C. A., & Parti, K. (2017). Defining Cyberbullying. Pediatrics, 140(Supplement 2): S148-S151.
- Fuentes, L., Ingerick, M., Jones, R., & Lindberg, L. (2018). Adolescents' and Young Adults' Reports of Barriers to Confidential Health Care and Receipt of Contraceptive Services. Journal of Adolescent Health, 62(1): 36-43.
- Hagan, J. F., Shaw, J. S., & Duncan, P. M., (Eds.). (2008). Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition. American Academy of Pediatrics.
- Harvard School of Public Health. (2001). Dating Violence Against Adolescent Girls Linked with Teen Pregnancy, Suicide Attempts, and Other Health Risk Behaviors.
- Henry J. Kaiser Family Foundation. (2010). Generation M2: Media in the Lives of 8- to 18-Year-Olds.
- Hinduja, S., & Patchin, J. W. (2013). Social Influences on Cyberbullying Behaviors Among Middle and High School Students. Journal of Youth and Adolescence, 42(5): 711-722.
- Kowalski, R. M., & Limber, S. P. (2012). Psychological, Physical, and Academic Correlates of Cyberbullying and Traditional Bullying. Journal of Adolescent Health, 53(1):S13-S20.
- Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (2002). World report on violence and health. Geneva, Switzerland: World Health Organization:1–56.
- Lyznicki, J. M., McCaffree, M. A., & Robinowitz, C. B. (2004). Childhood Bullying: Implications for Physicians. American Family Physician, 70(9):1723-1728.
- Mental Health America of Texas. “Stories of Hope” videos.
- Mercado, M. C., Holland, K., Leemis, R. W., Stone, D. M., & Wang. J. (2017). Trends in Emergency Department Visits for Non-Fatal Self-Inflicted Among Youth Aged 10 to 24 Years in the United States, 2001-2015. JAMA, 318(19): 1931.
- Mitchell, K. J., Hamby, S. L., Turner, H. A., Shattuck, A., & Jones, L. M. (2015). Weapon Involvement in the Victimization of Children. Pediatrics, 136(1): 10-17.
- Modecki, K. L., Minchin, J., Harbaugh, A. G., Guerra, N. G., & Runions, K. C. (2014). Bullying Prevalence Across Contexts: A Meta-Analysis Measuring Cyber and Traditional Bullying. Journal of Adolescent Health, 55 (2014) 602-611
- National Center for Missing and Exploited Children. (n.d.). Child Sex Trafficking Identification Resource.
- National Center for Victims of Crime. Bulletins for Teens: Dating Violence.
- National Center for Missing and Exploited Children. Missingkids.org.
- National Institute of Mental Health. (2015). Suicide in America: Frequently Asked Questions.
- Nock, M. (2010). Self-injury. Annual Review of Clinical Psychology, 6:339-363.
- O’Keefe, G. W., Clarke-Pearson, K., & Council on Communications and Media. (2011). The Impact of Social Media on Children, Adolescents, and Families. Pediatrics 127(4):800-804.
- Resnick, M. D., Ireland, M., & Borowsky, I. (2004). Youth violence perpetration: what protects? What predicts? Findings from the National Longitudinal Study of Adolescent Health. Journal of Adolescent Health, 35(5):424.e1-10.
- Rice, E., Gibbs, J, Winetrobe, H., Rhoades, H., Plant, A., Montoya, J., & Kordic, T. (2014). Sexting and Sexual Behavior Among Middle School Students. Pediatrics, 134(1):e21-e28.
- Rutherford, A., Zwi, A. B., Grove, N. J., & Butchart, A. (2007). Violence: a priority for public health? (part 2). Journal of Epidemiology and Community Health, 61(9):764–770.
- Satcher, D. (1995). Violence as a Public Health Issue. Bulletin of the New York Academy of Medicine, 72(1):46-56.
- Silenzio, V. M. B., Pena, J. B., Duberstein, P. R., Cerel, J., & Knox, K. L. (2007). Sexual Orientation and Risk Factors for Suicidal Ideation and Suicide Attempts Among Adolescents and Young Adults. American Journal of Public Health 97(11):2017-2019.
- Srabstein, J. C. (2009). Be aware of bullying: a critical public health responsibility. American Medical Association Journal of Ethics, 11(2):173-177.
- Temple, J. R., & Choi, H. (2014). Longitudinal Association Between Teen Sexting and Sexual Behavior. Pediatrics, 134(5): e1287-e1292.
- Temple, J. R., Paul, J. A., van den Berg, P., Le, V. D., McElhany, A., & Temple, B. W. (2012). Teen sexting and its association with sexual behaviors. Archives of Pediatrics and Adolescent Medicine, 166(9):828-822.
- Texas Association of School Administrators. (2017). David’s Law, Senate Bill 179.
- Texas Department of State Health Services. (2016). Adolescent Health Guide.
- Texas Suicide Prevention Council. (2014). Texas State Plan for Suicide Prevention.
- Texas Suicide Prevention Council. (2017). Training videos.
- Tucker, C. J., Finkelhor, D., Turner, H., & Shattuck, A. (2013). Association of Sibling Aggression with Child and Adolescent Mental Health. Pediatrics, 132(1): 79-84.
- U.S. Department of Health and Human Services. (2012). Rescue and Restore Victims of Human Trafficking.
- United Nations. (2016). Global Report on Trafficking in Persons.
- University of Michigan. (2006). Rapid Assessment for Adolescent Preventive Services (RAAPS).
- University of Michigan Health System Adolescent Health Initiative. Voices of Transgender Adolescents in Healthcare.
- Whitlock, J. L., Powers, J. P., & Eckenrode, J. E. (2006). The virtual cutting edge: the internet and adolescent self-injury. Developmental Psychology, 42(3):407–417.
- World Life Expectancy. (2016). Texas Causes of Death by Age and Gender.
- Yoo, W., Kim, S. Y., Hong, Y., Chih, M-Y., Shah, D. V., & Gustafson, D. H. (2015). Analyzing Text Messaging Between Adolescents with Asthma and Nurse Case Managers. Telemedicine and e-Health, 21(1): 62.69.
The medical definitions provided in this module were obtained or adapted from the Centers for Disease Control and Prevention, the Journal of Pediatric Health Care, the DNA Learning Center, the Mayo Clinic, the Personality and Social Psychology Bulletin, Psychology Today, WebMD, and the U.S. National Library of Medicine.
- pflag.org (originally Parents and Friends of Lesbians and Gays)
- Gay, Lesbian, and Bisexual Teens: Facts for Teens and Their Parents
- Self-injury handout for parents from the Cornell Research Program on Self-Injury and Recovery
- Texas Suicide Prevention Council. (2017). Training videos.
- Cyberbullying: Resources for parents
- Know Bullying App
- Break the Cycle
- Electronic Dating Violence: A Brief Guide for Educators and Parents
- Family Violence Prevention Fund: Create a Teen Safety Plan
- National Teen Dating Abuse Helpline
- Texas School Safety Center (TxSSC) Sexting Prevention Education Program, “Before You Text”
- Womenslaw.org: Getting Ready to Leave
Addressing Adverse Childhood Experiences through Trauma-Informed Care
Integrate practices to identify, treat, and reduce the effects of trauma and toxic stress among children and adolescents. Includes ethical guidelines for reporting suspected abuse or neglect and for providing culturally effective health-care services.
Behavioral Health: Screening and Intervention
Determine how and when to effectively screen for and treat common childhood and adolescent mental, emotional, and behavioral disorders in the primary care setting.
Teen Consent and Confidentiality
Establish practice guidelines that comply with legal requirements for obtaining consent and maintaining confidentiality in providing health-care services to adolescents.
Gain communication skills that can be used in the primary care setting to motivate children, adolescents, and families to make positive health changes, improve self-care for chronic conditions, and avoid high-risk behaviors.
Promoting Adolescent Health
Adopt best practices for adolescent screening, including recommended schedules, effective communication, and enhanced clinical procedures. Includes video examples of effective screening techniques.
Introduction to Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Learn how to conduct SBIRT in the medical office: instituting routine screening, early intervention, and referral to treatment for adolescent patients with substance use disorders or at risk for developing such disorders. Provides resources for obtaining mandatory SBIRT training.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.