6736 Quality Improvement: Increasing the Focus on Mental Health and Wellbeing in Adolescent Care

Objectives Rates of mental health disorders have increased from 1 in 9 children and young people (CYP) in 2017 to 1 in 6 in 2021.1 This is reflected in referrals to mental health crisis care teams which have more than tripled between May 2019 and May 2023.2 These sobering numbers demonstrate the need for an improvement in the approach to CYP and mental health. An RCPCH national CYP voicebank identified that CYP want to know about mental health support groups and resources.3 We designed a quality improvement project to address this need; aiming to increase the rates of signposting CYP to mental wellbeing resources using a Plan-Do-Study-Act (PDSA) structure. Methods We examined data on the frequency that inpatient adolescents, in a tertiary paediatric centre, were asked about their mental wellbeing via the HEADSSS psychosocial assessment tool 4 and the frequency of onward signposting. This data was collected at baseline and after each PDSA cycle. An initial questionnaire revealed existing signposting resources were not widely known about. Cycle 1 focused on spotlighting these using a QR code and poster linking to a directory of mental health resources. Feedback from cycle 1 highlighted a lack of confidence in how to approach these conversations. Cycle 2 comprised a teaching session on the HEADSSS assessment structure.4 Feedback from cycle 2 indicated professional anxieties around exploring these often highly emotive topics in real world cases. The third cycle comprised a simulation of a HEADSSS assessment designed to focus on approaching sensitive questions and de-escalation techniques. Results 56.6% of staff surveyed felt the biggest barrier to signposting was 'not knowing the available resources'. Additional barriers included clinical pressures such as 'lacking time' (19.5%) and environmental pressures such as 'lack of private areas' (12.2%).5 Figure 1 demonstrates the increase in HEADSSS assessments and onward signposting after each PDSA Cycle. During the course of the study, the rate of inpatient adolescents asked about their mental wellbeing increased from 8.6% to 72%. The rate of signposting rose from 8.6% to 25%. Qualitative feedback identified staff felt 'more empowered' and learned 'useful de-escalation and framing phrases' for their future practice.5 Conclusion Using quality improvement methodology and interventions built into existing teaching schedules, we have been able to empower staff in a tertiary paediatric hospital to have more frequent conversations with CYP about mental wellbeing. We observed a quantifiable increase in resulting signposting to mental health and wellbeing services. References Mental health of children and young people in England, 2022 follow up to the 2017 survey, NHS Digital, Date: January 2023. Urgent referrals of children to emergency mental health services tripled, Young Minds UK, August 2023. Doctor's pocketbook for talking to young patients about mental health, Royal College of Paediatrics and Child Health, 2016. Nicole Martin, Louise Ingram, Adam Bonfield. HEADSSS assessment, teach me paediatrics, July 2018. Quality improvement: increasing the focus on mental health and wellbeing in adolescent care, local data, September 2023