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Objectives As social determinants of health become increasingly relevant, there is a growing requirement to address the psychosocial needs of paediatric patients in acute healthcare settings.1 This is a prominent goal of the RCPCH.2 The recommended method of evaluation is the 'HEADSSS' (Home, Education/Eating, Activities, Drugs, Sexuality, Suicide, Safety) assessment.3 However, junior clinicians have expressed difficulties understanding the relevance and methodology of the components/completion of the assessment.4 This project aimed to evaluate current practice in a UK-based children's hospital as well as identifying whether there are changes in clinicians' decision making after completion of HEADSSS assessments. An aspirational aim is to assess if a tailored online training module increases confidence/competence in completing HEADSSS assessments in all over-12-year-olds admitted. Methods A literature review ascertained current understanding of the utility of HEADSSS assessments. A retrospective audit of HEADSSS assessments done in over-12-year-olds admitted to the medical ward over a 1-month period was completed. Rates of completion of HEADSSS assessments documented, the standard of HEADSSS assessment (against a gold standard as devised by three clinicians) and documentation of treatment/referral plans resulting from HEADSSS assessment were evaluated. A bespoke online training package for junior doctors on the importance/technique for applications of HEADSSS assessments, alongside video examples, has been created for implementation. Consultants will check weekly clinicians are completing HEADSSS assessments for all over-12-year-olds admitted for a 1-month period following training initiation. Efficacy of the interventions will be evaluated by a further audit. Junior doctors will be asked to provide feedback on the training. Results In the initial audit, 26% of patients had an assessment completed during their admission. Only 10% had a 'gold standard' proforma fully completed. All children with HEADSSS assessments completed presented with mental health concerns, however 29% of children presenting with mental health concerns did not have an assessment completed. The most common outcomes from completion of the assessment were: Referral to mental health services; Referral to eating disorder services; Referral to functional symptom management services. Of particular note, all HEADSSS assessments resulted in a new clinical decision. Outcomes of the training module will be evaluated between December 2023 and February 2024. Conclusion Clearly, there is an under-utilisation of psychosocial assessments in children admitted, regardless of presentation. This investigation will discover if an online training module improves rate and quality of assessments completed by junior doctors. In addition, and crucially, we aim to also evaluate the impact of a HEADSSS assessment. References Foley, et al. Evaluating documentation of social history in paediatric medical notes at a regional paediatric centre – a quality improvement initiative. 2020. Facing the Future: Standards for children in emergency care settings. RCPCH, 2018. Goldenring, Rosen. Getting into adolescent heads: An essential update. 2004. Alex, et al. Analyzing the knowledge among doctors on the relevance of HEADSSS assessment in young people and improving the assessment structure using quality improvement methodology. 2022.
Haeffner et al. (Tue,) studied this question.