Resident Physician Children's Hospital Los Angeles Children's Hospital Los Angeles Department of Pediatrics Los Angeles, California, United States
Background: HEADSS (Home/Education/Activities/Drugs/Sex/Suicide) assessments are adolescent psychosocial screening tools. Multiple organizations recommend such tools to address risk behaviors. Inpatient admissions may be an adolescent’s only exposure to the healthcare system, and present opportunities to screen patients to mitigate high risk behaviors.
Objective: Determine baseline HEADSS completion rates. Identify predictors of completion and factors that lead to interventions.
Design/Methods: A retrospective cohort study was conducted at a free standing children’s hospital. Adolescent patients (>12 years) admitted by resident physicians to non- intensive, non-oncology medical-surgical units were included, and 30 charts/month reviewed. Exclusion criteria were developmental delay, non-verbal, admission in last 28 days, death, admission <24 hours, and History and Physical not written by resident. Outcome measures were HEADSS completion and if concerning screens (≥ 1 non-reassuring response) led to intervention. Variables collected were age, sex/gender, race/ethnicity, admitting service, language, and post-graduate year of admitting resident. Chi-Square analyses and logistic regression models were performed to identify associations with HEADSS assessment completion rates and interventions.
Results: 600 charts were reviewed from 7/2018 – 2/2020 (Table 1). 52% of adolescents received HEADSS assessments. There were significant associations between HEADSS completion rates and PGY-status (54% from interns, 24% from senior residents, p<0.01) and admitting service (62% from general pediatric, 46% from subspecialty service, p<0.01) (Table 2). An interaction between black race and subspecialty admission was found (36% from black patients on subspecialty services, 55% from non-black patients and/or general pediatric services, p<0.01). 53% of patients with HEADSS assessments completed had concerning results, and 52% of those received some intervention (social work consult, testing, counseling, etc.). Admission to the general pediatrics service was found to be associated with higher intervention rates (Figure 1). Conclusion(s): HEADSS assessments are more likely to be done if interns completed H&P’s and if admitted to general pediatric services. Black patients on subspecialty services are less likely to receive assessments. Only 52% of concerning assessments resulted in intervention, with higher rates for patients on the general pediatrics service. Further steps will be to develop interventions to increase assessment completion.
Table 1. Demographic and admitting Information on the charts reviewed
Table 2. Odds Ratios and 95% Confidence Intervals (95%CI) for variables in relation to having HEADSS assessment completed. The three found to be significant (p < 0.05) are shown along with two other variables studies that were not found to be related to HEADSS completion rates. Adjusted Odds Ratios are from model incorporating admission by subspecialty service, admission by intern vs senior resident, and the interaction variable between black race and admission to a specialty service.
Figure 1. The percentages of HEADSS assessments that were positive in each psychosocial domain and the percentage of those assessments that received some form of intervention (with relative risk and 95% Confidence Interval).
Authors/Institutions: Christopher Schmitt, Children's Hospital Los Angeles Department of Pediatrics, Los Angeles, California, United States; Joyce Koh, Children's Hospital Los Angeles/USC, Los Angeles, California, United States; Claudia Borzutzky, Children's Hospital Los Angeles Department of Pediatrics, Los Angeles, California, United States; Susan Wu, Chidlren's Hospital Los Angeles/USC Keck School of Medicine, Los Angeles, California, United States
