Mario Cappelli1,2,3, Roger Zemek4,5,6, Christine Polihronis7,8, Nathalie R Thibedeau7, Allison Kennedy1,7, Clare Gray1,2,7, Mona Jabbour4,6, Sarah Reid4,6, Paula Cloutier1,7. 1. From the Mental Health Patient Service Unit, Children's Hospital of Eastern Ontario. 2. Departments of Psychiatry. 3. Psychology, University of Ottawa. 4. Emergency Department, Children's Hospital of Eastern Ontario. 5. Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute. 6. Department of Pediatrics, University of Ottawa. 7. Mental Health Research, Children's Hospital of Eastern Ontario. 8. Department of Psychology, Carleton University, Ottawa, Canada.
Abstract
OBJECTIVES: This effectiveness study aimed to evaluate the clinical use of the HEADS-ED tool for patients presenting to a pediatric emergency department (PED) for mental health (MH) care. METHODS: In this pragmatic trial, PED physicians used the HEADS-ED to guide their assessment and identify areas of MH need in 639 patients (mean [SD], 15.16 [1.40] years; female, 72.6%) who presented to the emergency department with MH concerns between May 2013 and March 2014. RESULTS: The HEADS-ED guided consultation to psychiatry/crisis, with 86% receiving a recommended consult. Those with a HEADS-ED score of greater than or equal to 8 and suicidality of 2 (relative risk, 2.64; confidence interval, 2.28-3.06) had a 164% increased risk of physicians requesting a consult compared with those with a score of less than 8 or greater than or equal to 8 with no suicidality of 2. The HEADS-ED mean score was significantly higher for those who received a consult (M = 6.91) than those who did not (M = 4.70; P = 0.000). Similarly, the mean score for those admitted was significantly higher (M = 7.21) than those discharged (M = 5.28; P = 0.000). Agreement on needs requiring action between PED physicians and crisis intervention workers was obtained for a subset of 140 patients and ranged from 62% to 93%. CONCLUSIONS: Results support the HEADS-ED's use by PED physicians to help guide the assessment and referral process and for discussing the clinical needs of patients among health care providers using a common action-oriented language.
OBJECTIVES: This effectiveness study aimed to evaluate the clinical use of the HEADS-ED tool for patients presenting to a pediatric emergency department (PED) for mental health (MH) care. METHODS: In this pragmatic trial, PED physicians used the HEADS-ED to guide their assessment and identify areas of MH need in 639 patients (mean [SD], 15.16 [1.40] years; female, 72.6%) who presented to the emergency department with MH concerns between May 2013 and March 2014. RESULTS: The HEADS-ED guided consultation to psychiatry/crisis, with 86% receiving a recommended consult. Those with a HEADS-ED score of greater than or equal to 8 and suicidality of 2 (relative risk, 2.64; confidence interval, 2.28-3.06) had a 164% increased risk of physicians requesting a consult compared with those with a score of less than 8 or greater than or equal to 8 with no suicidality of 2. The HEADS-ED mean score was significantly higher for those who received a consult (M = 6.91) than those who did not (M = 4.70; P = 0.000). Similarly, the mean score for those admitted was significantly higher (M = 7.21) than those discharged (M = 5.28; P = 0.000). Agreement on needs requiring action between PED physicians and crisis intervention workers was obtained for a subset of 140 patients and ranged from 62% to 93%. CONCLUSIONS: Results support the HEADS-ED's use by PED physicians to help guide the assessment and referral process and for discussing the clinical needs of patients among health care providers using a common action-oriented language.
Authors: Stephanie L Leon; Christine Polihronis; Paula Cloutier; Roger Zemek; Amanda S Newton; Clare Gray; Mario Cappelli Journal: J Can Acad Child Adolesc Psychiatry Date: 2019-03-01
Authors: Punit Virk; Samara Laskin; Rebecca Gokiert; Chris Richardson; Mandi Newton; Rob Stenstrom; Bruce Wright; Tyler Black; Quynh Doan Journal: BMJ Paediatr Open Date: 2019-07-24
Authors: Stephen Freedman; Jennifer Thull-Freedman; Teresa Lightbody; Kassi Prisnie; Bruce Wright; Angela Coulombe; Linda M Anderson; Antonia S Stang; Angelo Mikrogianakis; Lindy VanRiper; Michael Stubbs; Amanda Newton Journal: BMJ Open Qual Date: 2020-12