Background: The HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment is a psychosocial screening tool designed for the adolescent population. The American Academy of Pediatrics (AAP) and other organizations recommend using this assessment in order to address risk behaviors. However, as many of 69-80% of healthcare encounters don’t include such assessments. Inpatient admissions may be some adolescents’ only exposures to the healthcare system, and present an opportunity to screen patients and mitigate high risk behaviors. Objectives: Determine baseline completion rate of HEADSS and identify predictors of HEADSS completion and factors that lead to interventions when assessments are positive. Methods: We conducted a retrospective cohort study at a tertiary care free standing children’s hospital. Adolescent patients (>12 years) admitted by resident physician teams to non-oncology medical-surgical units were included, and charts from 30 discharges/month were reviewed. Exclusion criteria were developmental delay, non-verbal, admission within previous 28 days, death during admission, hospitalization <24 hours, and those whose admitting History and Physical (H&P) was not written by resident physicians. Outcome measures were HEADSS completion and whether positive screens (at least one non-reassuring response) led to an intervention. Variables collected were age, sex, gender, race, ethnicity, admitting service, primary language, and post-graduate year (PGY) of admitting resident. Chi-Square analyses and logistic regression models were performed to identify any significant associations with HEADSS assessment completion rates and factors related to interventions in each psychosocial domain (Home, Education, etc.). Results: 600 charts were reviewed from July 2018 - February 2020. 52% of adolescents received HEADSS assessments. There were significant associations between HEADSS completion rates and PGY-status (54% from interns vs 24% from senior residents, p<0.01) and admitting service (62% from general pediatric vs 46% from subspecialty services, p<0.01) (Table 1). Initially, significant differences were seen in completion rates for Black/African American patients vs. other races. However, this effect was attributable to an interaction between black race and subspecialty admission (36% from black patients on subspecialty services vs 55% from non-black patients and/or general pediatric services, p<0.01). 53% of patients with HEADSS completed had positive assessments, and 52% those received a form of intervention (social work consult, applicable testing, counseling, etc.). Admission to the general pediatrics service was found to be was associated with higher rates of initiating interventions in three psychosocial domains (Table 2). Conclusions: HEADSS assessments are more likely to be completed if interns completed H&P’s and if patients are admitted to general pediatric services. Black patients on subspecialty services are less likely to receive HEADSS assessments. Additionally, only 52% of positive assessments resulted in some form of intervention, with higher rates for patients on the general pediatrics service. Further steps will be to develop interventions to increase HEADSS assessment completion of hospitalized adolescents.

Logistic Regression Statistics for HEADSS Completion

Logistic Regression Statistics for HEADSS Completion

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Logistic Regression Statistics for HEADSS Completion performed by SAS PROC LOGISTIC. Cox and Snell R^2 = 0.0595. Nagelkerke R^2 (Max rescaled R^2 ) = 0.0794. Kendall’s Tau-a = 0.124. Goodman-Kruskal Gamma = 0.369. Somers’s Dxy = 0.248. c-statistic = 62.4%.

HEADSS Assessment Completion and Intervention Initiation by Admitting Service

HEADSS Assessment Completion and Intervention Initiation by Admitting Service

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The percentages of HEADSS assessments that were positive in each psychosocial domain and the percentage of those assessments that received some form of intervention. N is the total number of HEADSS assessments completed in each service. *p<0.05