Utility of a psychosocial assessment during an acute care hospitalization

Adolescence involves immense physical, cognitive, social and emotional changes, which can lead teenagers to partake in risky behaviors. While experimentation and risk-taking are critical components of an adolescent's development of autonomy, these behaviors are known to contribute to the morbidity, mortality and social concerns of this age group. This observation prompted national organizations like the American Academy of Pediatrics to recommend risk behavior screening on an annual basis. Based on this recommendation and the time constraints of outpatient clinicians, as well as teenagers' underattendance for routine outpatient visits, hospital-based clinicians should implement the no-missed-opportunities paradigm⁵ when caring for adolescent patients. An acute care hospitalization for a teenager should serve as an additional opportunity to provide preventive care services. Utilization of a psychosocial screening tool can augment a clinician's ability to risk-stratify an adolescent, thus alerting the clinician to provide additional resources, education or interventions during that hospital encounter. The acronyms HEADDSS (Home, Education, Activities, Diet, Drugs, Sexual activity/sexuality and Safety/suicide) and SSHADESS (Strengths, School, Home, Activities, Drugs, Emotions/eating, Sexuality, Safety) can be employed as tools to remember the various elements of an adolescent's psychosocial health. In order to solicit honest, in-depth responses during the assessment, hospital-based pediatricians should strive to establish an environment of mutual trust. Clinicians should ask open-ended questions, remain non-judgmental and should preface any conversation involving sensitive topics with a discussion regarding the patient's right to confidentiality (and the circumstances in which it may be breeched). If risky behaviors are identified during the assessment, then appropriate counseling or intervention should be arranged during the acute care stay, with an outpatient follow-up plan established prior to discharge. By including the provision of preventative services in the inpatient setting, pediatric healthcare providers stand to add an additional layer of support for the adolescent population.