43.2.3.13 Additional Adolescent ScreeningTobacco, Alcohol, and Drug Use Use Providers must ask about use of cigarettes and smokeless tobacco. Adolescents who use tobacco products should be assessed further to determine their patterns of use. A cessation plan should be provided for adolescents who use tobacco products. A dental referral should be made for all adolescents with a history of tobacco use. Providers must ask about the use of alcohol and other substances (marijuana, cocaine, paint/glue sniffing and others), and over-the-counter or prescription drugs (for nonmedical purposes), including anabolic steroids. Adolescents that report any use of alcohol or other drugs or inappropriate use of medicines during the past year should be assessed further about family history, circumstances surrounding use, amount and frequency of use, attitudes and motivation about use, use of other drugs, and the adequacy of physical, psychosocial, and school functioning. Adolescents whose substance use endangers their health should receive counseling and mental health treatment, as appropriate. Adolescents that use anabolic steroids should be counseled to stop using steroids and informed about the danger of sharing needles. The routine urine toxicology screening of adolescents is not recommended. Adolescents that use alcohol or other drugs should also be asked about their sexual behavior and use of tobacco products. Depression/Suicide Risk Providers must ask about behavior or emotions that indicate depression or suicide risk. Providers must perform screening for depression or suicide risk on adolescents that exhibit cumulative risk as determined by declining school grades, dysthymia, depressed or irritable mood, family dysfunction, homelessness, anxiety about sexual orientation, physical or sexual abuse, alcohol or other drug use, previous suicide attempt, and suicidal inclination or plans. If suicide risk is suspected, adolescents should be evaluated immediately and referred to a psychiatrist or other mental health professional, or they should be hospitalized for immediate evaluation. Nonsuicidal adolescents with symptoms of severe or recurrent depression should be evaluated and referred to a psychiatrist or other mental health professional for treatment. Learning Problems Providers must ask about learning or school problems and noise exposure (music, motorcycles, cars, etc.). Providers must assess adolescents for a history of truancy, repeated absences, or poor or declining performance that could interfere with school success. Conditions to assess include learning disabilities, attention deficit hyperactivity disorder, medical problems, abuse, family dysfunction, mental disorder, and alcoholic or other drug abuse. This assessment and the subsequent management plan should be coordinated with school personnel and the adolescent's parents or caregivers. Physical, Sexual, or Emotional Abuse Providers must ask about history of emotional, physical, and sexual abuse. If abuse is suspected, adolescents should be assessed to determine the circumstances surrounding the abuse and the presence of physical, emotional, and psychosocial consequences, including involvement in health risk behaviors. All health-care professionals are required to report all instances of suspected or confirmed abuse and neglect of adolescents and children. Regardless of whether the provider staff suspects that a report may have been previously made, a report must be made to one of the following:
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• Adolescents who report emotional or psychosocial sequelae should be referred to a psychiatrist or other mental health professional for evaluation and treatment. Reporting Suspected Sexual Abuse Reporting Abuse or Neglect, Rider 33 of Article II of the General Appropriations Act, House Bill (H.B.) 1, 78th Legislative Regular Session, 2003, requires DSHS to ensure all Medicaid providers comply with the provisions of state law as set forth in Chapter 261 of the Texas Family Code relating to investigations of child abuse and neglect reports, including suspected sexual abuse and HHSC reporting requirements. Refer to: "Child Abuse Reporting Guidelines (2 Pages)" for more information. Providers must use the "Child Abuse Reporting Guidelines, Checklist for HHSC Monitoring" to document referral of suspected abuse. Sexual Behavior/Sexually Transmitted Diseases (STDs) Providers must ask about involvement in sexual behaviors during a general screening.
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• STD Screening Procedures for Sexually Active Adolescents Sexually active adolescents should be tested for gonorrhea, chlamydia, syphilis, and HIV. Providers can refer to the following CDC website for further information on HIV testing: www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Consent for STD testing, including HIV, should be covered in the general consent. STD risk status includes the following:
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• Providers can call 2-1-1 Texas for referrals to HIV/acquired immunodeficiency syndrome (AIDS) testing sites; prevention, case management, and treatment providers; STD clinics; and other related service organizations. The Texas HIV/STD Community Resource Directory is available at www.dshs.state.tx.us/hivstd/services/default.shtm. Testing sites may also be found online at www.hivtest.org. Although HIV prevention counseling is not required, it is strongly recommended for high-risk adolescents and should include health guidance about responsible sexual behaviors, including abstinence. HIV prevention counseling should include the following:
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Department of Family and Protective Services (DFPS) if the alleged or suspected abuse involves a person responsible for the care, custody, or welfare of the client (DFPS Texas Abuse Hotline, 1-800-252-5400, operated 24 hours a day, 7 days a week).
