Screening for Sexual Activity and Sexual Risk Assessment

Clinical Service Goal

Sexual history and sexual risk assessments are foundational ASRH services. These screening practices enable care teams to identify risk behaviors and offer protective interventions.

Key Foundations

Strategies related to assessment, policy, and environment

Equipping Teams

Strategies that build clinic staff capacity

Service Delivery

Strategies to strengthen processes, procedures, and systems involved in delivering clinical services

Engaging Adolescent Patients and Families

Strategies to educate and build productive partnerships with adolescents and their families+ (These strategies recognize the important role that parents can play in relation to ASRH, even while protecting confidentiality remains a cornerstone of adolescent care).

Strategies

Key Foundations

Equipping Teams

Tools & Resources

Sexual History-Taking: Essential Questions

Adolescent Reproductive and Sexual Health Education Program, Physicians for Reproductive Health

Slide deck on adolescent sexual history taking (Addresses LGBTQIA+ youth)

A Guide to Taking a Sexual History

Centers for Disease Control and Prevention

A framework for discussing sexual health issues to assess and screen patients for a broad range of sexual health concerns

Health is Power

The Partnership for Male Youth/American Sexual Health Association/ School-Based Health Alliance/Healthy Teen Network

Tool that offers care team members tips on how to have a frank conversation and build rapport with young men during a well visit; includes questions regarding sexual health and other topics (Note that vaccine recommendations on page 2 may be dated). Pair it with the Your Health is Your Power Self- Assessment Tool (Addresses male ASRH)

Service Delivery

Implementation Tips

Incorporate a sexual risk assessment as part of a broader health assessment
In addition to risks, assess the adolescent patient’s strengths with regard to knowledge, skills, and behaviors
Use process mapping techniques or co-design to document current clinic workflow and identify where risk assessment best fits
Use adolescent-friendly tablet-based technology to capture sexual activity history and sexual risk in a confidential manner
Send assessment tools via text message to be completed ahead of the clinic visit

Tools & Resources

Sample Workflows (with Adolescent Risk Screening Starter Guide)

Adolescent Health Initiative

Sample workflows for confidential risk screening on page 3

Broader Risk Assessment Tools

SSHADESS Screen

American Academy of Pediatrics

Screening assessment for strengths, school, home, activities, drugs, emotions/depression, sexuality, and safety

Detailed Sexual Risk Assessment Tools

Taking a Client-Centered Sexual History (within Sexual and Reproductive Health Toolkit for Adolescent Providers)

Adolescent Health Working Group

Detailed sexual history questionnaire on pages 20-22

Asking Essential Sexual Health Questions

National Coalition for Sexual Health

Essential questions to ask patients about their sexual health; specific questions for adolescents included on pages 4 and 5 and on this provider pocket card

Your Health is Your Power Self-Assessment Tool

The Partnership for Male Youth/American Sexual Health Association/ School-Based Health Alliance/ Health Teen Network

Patient-facing assessment designed for young men to complete prior to visit; pair it with Health is Power (Addresses male ASRH)

Service Delivery

Implementation tips

Use EHR prompts or templates
Work with health informatics staff and consult with your Health Center Controlled Network (HCCN) or Primary Care Association (PCA) to tailor the health center’s EHR system to facilitate sexual history taking and risk assessment

Engaging Adolescent Patients and Families

Implementation tips

Discuss adolescent development and the importance of a sexual risk assessment with parents and answer any questions they may have
Provide resources on parent-adolescent communication and adolescent health and development
Have parents complete a health assessment regarding their adolescent’s general health to help involve them in their child’s care and make them feel included

Tools & Resources

Adolescent Parent/Guardian Questionnaire

Adolescent Health Initiative

Example questionnaire for parents to complete that assesses parents’ experience of parenting their adolescent; recent changes in family, e.g., birth or divorce; and parent-adolescent communication on a variety of risk topics

Growth and Development, Ages 18 and Over: What Parents Need to Know

Advocates for Youth

Developmental guidelines for parents on physical, cognitive, emotional, and sexual development in adolescents