Clark Sharon E, Cloutier Paula, Polihronis Christine, Cappelli Mario
Mental Health and Addiction Services, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada;
Mental Health Research and.
Hosp Pediatr. 2019 Feb;9(2):107-114. doi: 10.1542/hpeds.2018-0112.
We evaluated the use of a mental health (MH) screening tool in a hospital-based centralized MH referral telephonic intake process. The tool is used to guide psychosocial screening in several domains: home; education; activities and peers; drugs and alcohol; suicidality; emotions, thoughts, and behaviors; and discharge resources (HEADS-ED). We wanted to understand the use of the tool to guide next step in care decision-making over the telephone.
Intake workers used the HEADS-ED tool to guide the assessment processes, identified areas of MH need, and made decisions about next step in care. We completed a retrospective chart review of all callers to the intake system over 4 months to gather initial decision at intake and subsequent steps in treatment. χ and analysis of variance tests were used to examine differences between HEADS-ED scores and next step in care.
A total of 674 patients aged 3 to 19 years (mean age = 11.7 years, SD = 0.6; girls = 50.0%) called for services. Significant mean differences were found on total HEADS-ED scores between treatment options (F = 75.76; < .001). Decision validity indicated that 86% ( = 506 of 587) of initial referrals matched treatments that were actually received. Uptake of the tool was 100%, and interrater reliability indicated strong agreement between raters (intraclass correlation coefficient = 0.82; < .001).
With our results, we support the use of the HEADS-ED tool in a telephone-based MH intake system to help guide the initial assessment and inform decision-making about fit of next step in care, both within the health center-based MH system and in the community.
我们评估了一种心理健康（MH）筛查工具在医院集中式MH转诊电话接诊流程中的应用。该工具用于指导多个领域的心理社会筛查：家庭；教育；活动与同伴；药物与酒精；自杀倾向；情绪、思维和行为；以及出院资源（HEADS-ED）。我们希望了解该工具在电话中指导下一步护理决策的应用情况。
接诊工作人员使用HEADS-ED工具指导评估过程，确定MH需求领域，并就下一步护理做出决策。我们对4个月内所有打进接诊系统的来电者进行了回顾性病历审查，以收集接诊时的初步决策和后续治疗步骤。使用χ检验和方差分析来检验HEADS-ED评分与下一步护理之间的差异。
共有674名3至19岁的患者（平均年龄 = 11.7岁，标准差 = 0.6；女孩占50.0%）来电寻求服务。在不同治疗选项的HEADS-ED总分上发现了显著的平均差异（F = 75.76；P < .001）。决策有效性表明，86%（587例中的506例）的初始转诊与实际接受的治疗相匹配。该工具的使用率为100%，评分者间信度表明评分者之间有很强的一致性（组内相关系数 = 0.82；P < .001）。
基于我们的结果，我们支持在基于电话的MH接诊系统中使用HEADS-ED工具，以帮助指导初始评估，并为健康中心的MH系统和社区内下一步护理的适配性决策提供信息。
