PC2006: Improving HEADSS Assessments for Inpatient Adolescents: A Quality Improvement Initiative

Purpose/Objectives: Adolescents have distinctive psychosocial needs due to their stage in cognitive, social and emotional development. While the HEADSS assessment, a validated tool used to screen adolescents for risk behaviors, mental health and safety issues, is taught to adolescent health providers, studies show that adolescents are inadequately screened, leading to missed opportunities for intervention. Hospitalizations provide a unique context for screening adolescents but are underutilized. Our team designed a quality improvement initiative to increase the frequency, completeness and compliance of HEADSS assessment documentation for hospitalized teens.

Design/Methods: Charts were reviewed for all patients ages 12-24 admitted to the pediatric ward or intensive care unit at Kaiser Permanente Oakland Medical Center), excluding only patients on the adult surgery team, during (1) the pre-intervention period (July 2019 – September 2020) (n = 480) and (2) the post-intervention period (March – December 2021), combining data following each of the three intervention stages lasting for three weeks each (n=61). The multi-staged intervention included didactic programs for residents, release of electronic note templates, email reminders and physical workspace prompts. The pediatric history and physical and progress notes within the first 48 hours were reviewed for documentation in seven HEADSS domains: home, education/employment, activities, drugs/alcohol, sexuality, mental health, and safety. Patient demographic characteristics included sex assigned at birth, primary language, and race/ethnicity. Descriptive statistics were used to describe HEADSS documentation completeness and patients.

Results: Pre-intervention data revealed complete HEADSS assessments documented in 9% of adolescent admissions compared to 15% in the post-intervention period, with four or more HEADSS domains documented in 22% of admissions, compared to 20% in the post-intervention period. Across both the pre and post intervention periods, female patients received higher rates of screenings and were screened twice as often as males in the sexuality, mental health and safety domains. No documentation reviewed met best practice compliance guidelines.

Conclusion/Discussion: After several interventions, rates of complete HEADSS assessments for hospitalized adolescents improved. However, combined rates of adequate and complete assessments remained low. More work is necessary to remove barriers to performing HEADSS assessments, improve screening rates and meet confidential documentation guidelines in the inpatient setting.