CHEO Research Institute creates novel tool to help assess kids in crisis
In recent years there has been a marked increase in the demand for mental health services among the pediatric population in Ontario. CHEO, being one of the largest providers of child and youth mental health services, has seen firsthand a sharp increase in the number of children requiring its services.
To address this, CHEO has become a very active player to champion this cause for the children, youth and families it serves.
Dr. Mario Cappelli, a clinical psychologist who serves as the Director of Psychiatric and Mental Health Research at CHEO, has been hard at work at the CHEO Research Institute focusing on the mental health of children, youth, and families. One of his objectives was to identify where the most substantial needs were and to offer mental health services to the children and youth in a community integrated manner.
One of his research projects that has garnered a lot of attention is the HEADS ED tool that he and his team developed to help manage children and youth in crisis whose parents rush them to the Emergency department (ED) in need of immediate assistance, not knowing where else to turn or being unable to assess the severity of the situation.
“It became pretty clear to us that there was no standard of practice or existing tool to help guide the assessment or disposition of mental health concerns within Emergency departments,” explains Cappelli. “We therefore aimed to create a tool to assess mental health distress including suicide risk for centres that treat youth, because a growing number of young people visit the Emergency room with dire mental health needs.”
The standardized online assessment tool is a survey that evaluates a patient’s behaviour, feelings and background.
The HEADS ED tool enables Emergency department physicians to assess the psycho-social history of patients to help guide them. It makes it easy for physicians to identify children and youth with severe mental health issues, as well as help them find local help and resources.
HEADS ED incorporates seven variables that together paint a portrait of how substantial the youth’s needs are: Home, Education, Activities and peers, Drugs and alcohol use, Suicidality, Emotions, behaviours, thought disturbance, and Discharge resources.
The tool is also linked to listings of community resources that ED physicians can offer patients and their families at the time of discharge.
“I knew that community resources and agency information is accessible in Emergency departments,” adds Cappelli. “But never before had the information been collated online, in such a way that the reports are directly aligned to the patient’s risk assessment — and readily available.”
The assessment tool has been proven to be a good predictor of the severity of the crisis the patient is in and enables ED physicians to better identify which patient needs immediate help and which one can be given the proper tools and local resources to get the help they need.
“I think what’s really compelling is how simple we’re making it for physicians to recommend an action plan when a patient leaves the hospital. Say for example, if a physician learns that a patient’s home life is supportive and they have no problems with their peers, but there is some drug use and suicidal ideation, then the HEADS ED tool will grade the severity of the case and turn out a list of agencies that can provide ongoing support.”
Following a multi-site study in Ottawa and Halifax, assessing the facilitators and barriers to implementing the HEADS-ED in pediatric hospitals community and agency resources within the tool were regionalized to ensure that it offered local services for each pediatric centre across the nation. The HEADS-ED tool is now being used across Canada, from Nova Scotia to Interior British Columbia.
“I know one thing for sure: Children and youth are CHEO’s patients, but our clients are their parents and guardians,” says Cappelli. “I am really excited that we can point them to the appropriate community and hospital resources and give families a meaningful action plan when they leave the Emergency department.”
The HEADS-ED was created by Dr. Mario Cappelli and the HEADS-ED development team: Dr. Roger Zemek, Paula Cloutier, Dr. Clare Gray, Dr. Allison Kennedy, Heather Bragg, Nathalie Thibedeau, Elizabeth Glennie, Dr. Mona Jabbour, and Dr. John Lyons. Cappelli hopes to see facilities across the country and even internationally use the HEADS ED tool to better help the children and youth who need help on their way to better resiliency.
What’s really compelling is how simple we’re making it for physicians to recommend an action plan when a patient leaves the hospital DR. MARIO CAPPELLI, CHEO Director of Psychiatric and Mental Health Research