Improving compliance with conducting HEADSS biopsychosocial assessment for adolescents in a paediatric inpatient setting

Adolescence is a period during which teenagers are at a high risk of developing mental health problems. Early recognition and intervention for mental health symptoms can prevent progression of high-risk behaviours or worsening of serious psychiatric conditions. The HEADSS assessment is an internationally recognised tool used to facilitate the biopsychosocial evaluation of an adolescent comprising domains in home, education, eating behaviours, activities, drug exposure, sexual activity, sleep, mood and suicidality. A self-administered HEADSS screening tool, comprising 11 questions, was developed and implemented in our hospital for all adolescents admitted to inpatient wards. The HEADSS screening tool is initiated by a nurse and, when screened positive, triggers a HEADSS assessment performed by a clinician to evaluate various domains of HEADSS. A hospital-wide audit reflected poor compliance with HEADSS assessments being conducted, despite domains of concern being flagged during HEADSS screening. A multidisciplinary team was created to address this issue. Following a root cause analysis, the team implemented the following interventions: improving the clarity and specificity of the HEADSS screen, improving communication between nursing and medical staff via educational update sessions and automated handover reports and implementing a targeted HEADSS assessment to focus on domains of concern. There was a statistically significant improvement in the median percentage of compliance to HEADSS assessment to 85% (from 40% at baseline) after implementing these measures. This improvement in compliance with HEADSS assessments resulted in an increase in referrals to mental health and allied health professionals, providing at-risk youth with necessary mental health support and interventions at the early stages of their difficulties.