UBC Theses and Dissertations
Pediatric psychosocial evaluation in the emergency department Virk, Punit
The American Academy of Pediatrics has prioritized standardizing psychosocial evaluation and screening interventions in the emergency department, to improve the detection and care of youth with identified or unrecognized mental health issues. Few standardized tools exist covering a range of issues and are designed and psychometrically evaluated for use in the emergency department. A digital evidence-based, clinically-informed youth psychosocial assessment and disposition guidance tool (HEARTSMSAP) was developed, addressing this need. A preliminary evaluation found the tool to have good predictive validity and interrater reliability among pediatric emergency clinicians. This research aimed to expand the use of the clinical HEARTSMAP tool beyond strictly the pediatric emergency clinician population, through two connected but separate investigations. In study one, HEARTSMAP’s interrater reliability was evaluated among different emergency clinician-types, working in diverse emergency settings (n=16). Clinicians displayed moderate to near-perfect interrater scoring agreement in applying HEARTSMAP to fictional vignettes, with weighted kappas on tool sections ranging from 0.46 (Professionals & resources; 95% CI: 0.40, 0.46) to 0.93 (Alcohol & drugs; 95% CI: 0.93-0.94). Study two was a multi-phase, multi-method study to adapt the clinical tool into a lay self-administered version for youth and families. First, focus groups were conducted in a community-based sample of youth and parents (n=38), to inform tool modification. Feedback focused on the need for MyHEARTSMAP to be approachable and interpretable for end-users, and evidence was found supporting the tool’s content and face validity. Second, community-based youth and parents applied the latest MyHEARTSMAP version to fictional vignettes. Participants reliably scored psychosocial issues using MyHEARTSMAP, displaying substantial to near-perfect interrater agreement on tool sections, with weighted kappas ranging from 0.76 (Professionals & resources; 95% CI: 0.73, 0.79) to 0.98 (Alcohol & drugs; 95% CI: 0.97-0.98). Together, these studies suggest that clinician- and self-administered psychosocial evaluation can be consistently conducted by diverse emergency clinicians, youth, and parents. Ongoing evaluations will assess HEARTSMAP’s impact on ED patient flow (e.g., length of stay, rate of return visit, rate of hospitalization), and MyHEARTSMAP’s interrater reliability and validity among emergency department visiting youth and families, in predicting ED disposition (discharge or admission) and clinician’s service referrals.
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