Dr Katherine Malbon (Paediatric Consultant, Imperial Healthcare NHS Trust)
Dr Kate Sullivan (Paediatric Registrar, Imperial Healthcare NHS Trust)
Dr Harsh Samarendra (Paediatric SHO, Imperial Healthcare NHS Trust)
In 2016, The Lancet Commission declared that there is a “triple benefit” to be gained from investment in adolescent health, as improvement is seen in their current health and wellbeing, and extends into adulthood, which benefits the next generation (Patton et al, 2016). During adolescence, significant changes in biological and psychosocial development occur concurrent with increased morbidity related to risk-taking behaviour and psychosocial distress (Currie et al, 2009). These issues are amenable to prevention efforts; longitudinal studies suggest that identifying psychosocial issues and referring appropriately has a positive impact on adolescent wellbeing (Walker et al 2002; Ozer et al 2005).
Research suggests that it is difficult for adolescents to access healthcare that adequately addresses their psychosocial needs; and they may resist discussing these sensitive issues unless they are asked directly and confidentially (Sanci et al, 2005). Early identification of concerns enables health professionals to deliver education and implement timely and appropriate interventions, and reduce the associated harm (Patton et al, 2016). Psychosocial screening tools such as HEADSSS, an acronym detailing aspects of an adolescent’s life to be explored through a series of screening questions, are one method of enabling this (Smith & McGuinness, 2017).
Despite the importance of HEADSSS screening, a recent audit we conducted demonstrated room for improvement in this practice. Approximately 5000 young people aged 13 to 20 years present annually to St Mary’s Hospital Emergency Department (Sullivan, Samarendra & Malbon, 2019). Of these, 12% attend following drug use, alcohol intoxication, self-harm or assault; yet recent quantitative audit data reveals low rates of adolescent psychosocial screening (Sullivan, Samarendra & Malbon, 2019). A qualitative study exploring barriers and perceptions of HEADSSS amongst Imperial staff revealed lack of knowledge around HEADSSS screening as a significant barrier. We sought to address this barrier by designing and conducting a multidisciplinary adolescent health teaching program, including a multidisciplinary sequential simulation afternoon in conjunction Imperial College patient Experience Hub.
We delivered a weekly Adolescent Health teaching program over a 4 week period during March 2019, targeting Paediatric and Adult Emergency staff, paediatric doctors, nurses and allied health staff. The teaching program culminated in a 3 hour multidisciplinary sequential simulation afternoon in which staff put these skills into practice. To assess the success of the program, we collected feedback from participants and are in the process of re-auditing rates of HEADSSS screening in St Mary’s Emergency Department.
Progress made: What have you learned from doing this?
Lack of knowledge is one important barrier affecting HEADSSS screening and warrants targeted teaching programs to specifically address this problem. The multidisciplinary teaching sessions received excellent feedback from staff and are a promising way to increase knowledge and culture change around adolescent health and HEADSSS screening. However, knowledge is not the only barrier to conducting HEADSSS screening, and the impact of our teaching program on HEADSSS screening rates remains to be seen.
What’s your take home message?
Risk assessment using a psychosocial screening tool is an essential part of developmentally appropriate holistic care for young people and should be the responsibility of all patient facing healthcare professionals.
Currie, C., Zanotti, C., Morgan, A., Currie, D., De Looze, M., Roberts, C., … & Barnekow, V. (2009). Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the, 2010, 271.
Ozer, E. M., Adams, S. H., Lustig, J. L., Gee, S., Garber, A. K., Gardner, L. R., … & Irwin, C. E. (2005). Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention. Pediatrics, 115(4), 960-968.
Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., … & Kakuma, R. (2016). Our future: a Lancet commission on adolescent health and wellbeing. The Lancet, 387(10036), 2423-2478.
Sanci, L. A., Sawyer, S. M., Kang, M. S., Haller, D. M., & Patten, G. C. (2005). Confidential health care for adolescents: reconciling clinical evidence with family values. Medical journal of Australia, 183(8), 410.
Smith, G. L., & McGuinness, T. M. (2017). Adolescent Psychosocial Assessment: The HEEADSSS. Journal of psychosocial nursing and mental health services, 55(5), 24-27.
Sullivan, K., Samarendra, H., & Malbon, K. (2019). Adolescent Psychosocial History using HEADSSS in a tertiary paediatric emergency department. Manuscript submitted for publication, Imperial NHS Healthcare Trust, London.
Walker, Z., Townsend, J., Oakley, L., Donovan, C., Smith, H., Hurst, Z., … & Marshall, S. (2002). Health promotion for adolescents in primary care: randomised controlled trial. bmj, 325(7363), 524.