Evaluating the HEADS-ED Screening Tool in a Hospital-Based Mental Health and Addictions Central Referral Intake System: A Prospective Cohort Study

Hosp Pediatr. 2019 Feb;9(2):107-114. doi: 10.1542/hpeds.2018-0112.


Objectives: 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.

Methods: 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. χ2 and analysis of variance tests were used to examine differences between HEADS-ED scores and next step in care.

Results: 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 (F4,641 = 75.76; P < .001). Decision validity indicated that 86% (n = 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; P < .001).

Conclusions: 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.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Behavior, Addictive / diagnosis
  • Child
  • Child, Preschool
  • Clinical Decision-Making / methods*
  • Female
  • Hospitals
  • Humans
  • Male
  • Mental Disorders / diagnosis*
  • Mental Health Services* / organization & administration
  • Observer Variation
  • Prospective Studies
  • Psychiatric Status Rating Scales*
  • Referral and Consultation* / organization & administration
  • Reproducibility of Results
  • Telemedicine / methods*
  • Telemedicine / organization & administration
  • Telephone*
  • Young Adult