Digital psychosocial assessment of youth in Australian hospitals: From aspiration to implementation

BACKGROUND: Some of the leading causes of morbidity and mortality for Australian youth arise from modifiable psychosocial concerns. Psychosocial assessment can help identify young people at risk and support actions that protect wellbeing. The gold standard assessment for youth is the HEEADSSS interview. Australian governments recommend the HEEADSSS interview for young people in health settings, but adoption is still in its early stages. Recently, a digital self-assessment version of the HEEADSSS (the e-HEEADSSS) was piloted at the Sydney Children's Hospital Network. A program of research has been established to evaluate outcomes and consider broader implementation. METHODS: Study 1 involved a retrospective analysis to compare the HEEADSSS interview and the e-HEEADSSS. Documentation from 146 matched records collected at the Sydney Children's Hospital Network were analysed to compare approaches. Study 2 utilised a qualitative design to evaluate patient and staff barriers and facilitators to implementation and scale-up of the e-HEEADSSS. Patients (n = 8) and staff (n = 8) participated in online semi-structured interviews. RESULTS: Study 1 found the e-HEEADSSS improves assessment uptake and sensitivity compared to face-to-face interviews and takes less time. Disclosure rates were higher for all psychosocial categories especially in sensitive areas of emotions, drug use, sex, and safety. Study 2 found strong support for the e-HEEADSSS from patients and staff. Key benefits included design, functionality, reduced time, convenience, improved disclosure, perceived privacy, improved fidelity, and reduced stigma. Key challenges were available resources, continuity of staff training, clinical pathways, and risks of off-site completions. CONCLUSIONS: The e-HEEADSSS shows promise as a psychosocial screening tool to support intervention for young people. More work is required to appropriately scale and sustain implementation of the e-HEEADSSS within the Australian health system. KEY MESSAGES: • Digital psychosocial assessments show promise for supporting the mental and physical health of adolescents and young adults. • Implementation of digital psychosocial assessments within the Australian health system requires considered support.