104 - Universal Psychosocial Screening Using MyHEARTSMAP in Hospitalized Pediatric Patients: A Randomized Control Trial

Publication Number: 104.6621

Rebecca Liu, University of British Columbia, Richmond, BC, Canada; Alyssa Chong, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Ian Pierce, Northern Ontario School of Medicine, Sudbury, ON, Canada; Sydney Sparanese, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Jeffrey N.. Bone, BC Children's Hosiptal Research Institute, Vancouver, BC, Canada; Quynh Doan, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada

Background: Hospitalized youth and those with acute or chronic illness experience disproportionate mental health burdens. Presentation to the pediatric emergency department (PED) for admission provides an opportunity to initiate standardized psychosocial screening. Our team developed and validated MyHEARTSMAP, a resource-efficient psychosocial self-screening tool, to assist in universal screening of pediatric patients.

Objective: Our primary objective was to compare the proportion of participants who received mental health consultation from psychiatry, psychology, social work, adolescent medicine, or allied health services, between the control group and those who received MyHEARTSMAP screening upon admission (intervention group). Secondarily, we explored the utilization and patient perception of recommended psychosocial resources at 3 months post-discharge.

Design/Methods: This randomized controlled trial was conducted between August 2021 and May 2023 in a Canadian PED. Figure 1 details inclusion/exclusion criteria. Upon admission, those in the intervention group completed the MyHEARTSMAP tool, and screening results were shared with treating teams to guide patient care. The control group received the treating team’s standard psychosocial screen (if existent) during admission and completed the MyHEARTSMAP tool after discharge. We reviewed health records at discharge to document in-hospital management. Logistic regression modeling was used to evaluate the effect of screening on psychosocial intervention over the hospital stay. ​​3-month follow-up outcomes were summarized by descriptive statistics.

Results: The intervention group had a higher psychosocial intervention rate (40.4%) compared to the control group (32.9%) (RR=1.28, 95% CI[0.95, 1.73], p=0.109). When looking only at those who screened positive for any psychosocial concern, the intervention group had a statistically significant higher psychosocial intervention rate (41.3%) compared to the control group (25.1%) (RR=1.60, 95% CI[1.04, 2.46], p=0.0318). At 3 months post-discharge, both groups had similar recall rates for recommended resources, with modest engagement in mental health and primary care services. Barriers to accessing support included financial burden, transportation, wait times, patient availability, and limited resource knowledge.

Conclusion(s): This study demonstrates that universal mental health screening can help identify those at psychosocial risk, facilitating timely intervention. MyHEARTSMAP shows promise as a low-barrier tool for clinicians to effectively address physical and mental health needs, promoting holistic care of pediatric patients.

Figure 1: CONSORT diagram
a. Outside of study age range (7-17 years), not a BC resident, admitted to another specialty not involved in this study, no parent/guardian, no translator available
b. Previously enrolled in this study, ICU admission, primary psychiatric concern, unable to consent/assent, no internet
c. Care team advised not to approach, unable to approach before admission due to patient condition, or insufficient enrolment time
d. Pain, tired, not interested in research, or already involved with other studies

Table 1: Proportion of patients receiving psychosocial intervention over the in-patient stay or at discharge by category type
a. Subgroup analysis includes those who screened positive for any psychiatric, social, youth health, function, or abuse concern
b. Includes: endocrinology, nephrology, cardiology, neurology, gastroenterology, urology
c. Includes: orthopaedics, general surgery

Figure 2: 3-month outcome comparison between study group participants with psychosocial support service recommendations
MH = mental health

Figure 1: CONSORT diagram
a. Outside of study age range (7-17 years), not a BC resident, admitted to another specialty not involved in this study, no parent/guardian, no translator available
b. Previously enrolled in this study, ICU admission, primary psychiatric concern, unable to consent/assent, no internet
c. Care team advised not to approach, unable to approach before admission due to patient condition, or insufficient enrolment time
d. Pain, tired, not interested in research, or already involved with other studies

Table 1: Proportion of patients receiving psychosocial intervention over the in-patient stay or at discharge by category type
a. Subgroup analysis includes those who screened positive for any psychiatric, social, youth health, function, or abuse concern
b. Includes: endocrinology, nephrology, cardiology, neurology, gastroenterology, urology
c. Includes: orthopaedics, general surgery

Figure 2: 3-month outcome comparison between study group participants with psychosocial support service recommendations
MH = mental health