6916 Inside ‘HEEADSSS’: what a psychosocial risk assessment tool can reveal and the importance of quality improvement initiatives in promoting its use

Objectives The HEEADSSS assessment is a psychosocial risk assessment tool for adolescents. Used appropriately it can extract relevant risk and protective factors pertaining to adolescent health and well-being which ensures they're treated using a biopsychosocial model of care. The Emergency Department (ED) represents accessible healthcare for some vulnerable adolescents, and as such it is often their first port of call when in crisis2. Raising awareness of HEEADSSS amongst ED staff is essential to its appropriate use and overall sensitivity, which directly impacts the quality of patient specific management plans. Methods Adolescent ED attendances to Children's Health Ireland (CHI) at Crumlin, in April 2023 and June 2023 were examined using Symphony, an electronic patient medical record database. Data points included age, gender, presenting complaint, time of presentation, whether a HEEADSSS assessment was completed, the relevant findings, clinical outcomes and presence of pre-existing medical conditions. This three phase study first involved a review of current practice. Phase two saw several quality improvement initiatives aimed at improving the overall visibility and awareness of HEEADSSS being implemented. A staff education session was held where a blank proforma was introduced and 'aide-memoire' lanyard attachments distributed. Digital visibility also increased, screen saver reminders appeared on all desktops in the ED and weekly emails were sent. The third and final phase assessed the efficacy of these interventions, using Symphony to generate a list of attendances in the month following the intervention phase. Results 409 charts were retrospectively analysed (210 pre intervention and 199 post intervention). There was an improvement of 277% in the use of HEEDASSS following the implementation of educational interventions (P value Conclusion The interventions used in this study to raise awareness of the appropriate use of HEEADSSS were effective. A functional HEEADSSS assessment is a useful clinical tool that facilitates bespoke care pathways. It enables a bio-psycho-social model of care which is the hallmark of effective treatment for a lot of adolescent ED presentations.3 4 References Cohen E, MacKenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health 1991;12(7):539–544. Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361–365. doi:10.1001/archpedi.154.4.361. Brill SR, Patel DR, MacDonald E. Psychosomatic disorders in pediatrics. Indian Journal of Pediatrics. 2001;68(7):597–603. https://doi.org/10.1007/BF02752270. Ibeziako P, Bujoreanu S. Approach to psychosomatic illness in adolescents. Current Opinion in Pediatrics. 2011;23(4):384–389.