Background/Purpose: Adolescent patients cared for in the pediatric rheumatology clinic balance challenges related to psychosocial stressors and physical growth with the complexities of living with a chronic medical condition. Due to the interplay between these factors, it is important that all providers for adolescent patients conduct appropriate psychosocial screenings to better identify at risk patients and address their unique healthcare needs. The HEADSS assessment (home, education/employment, activities, drugs, sexuality, suicide/depression) is a validated tool that provides a framework to comprehensively screen for psychosocial risk factors. The objective of this study was to identify targets to improve psychosocial screening of adolescent patients presenting to the pediatric rheumatology clinic by assessing current practice patterns and perceived barriers to screening by pediatric rheumatology fellows.

Methods: This is a descriptive survey-based study sent to active fellow-in-training members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Responders completed a secure web-based survey using REDCap (Research Electronic Data Capture) to assess current practices, beliefs, and barriers regarding the utilization of the HEADSS assessment.

Results: Of the 99 eligible CARRA fellow members, 57 responded (58%) and 53 completed the survey in its entirety. All but two responders are currently training in the United States, and the majority (81%) reported practicing in an urban setting. Sixty-one percent agreed or strongly agreed that a full comprehensive HEADSS assessment should be completed on all adolescent patients seen in the pediatric rheumatology clinic; however, only 38% reported often conducting a full HEADSS assessment on new adolescent patients, and 26% often conducted a full HEADSS assessment on established adolescent patients annually. Frequencies of conducting individual components of the HEADSS assessment are summarized in Figure 1. Of these, sexual orientation and gender identity (SOGI) data were cited as being the least frequently collected information. Barriers to screening are summarized and ranked in Figure 2. The most commonly cited barriers to screening were lack of time and providers not knowing what to do with positive screens. Fifty-seven percent of responders cited interest in receiving additional training in application of the HEADSS assessment. Sixty-five percent cited interest in receiving additional training in collecting SOGI information.

Conclusion: Pediatric rheumatology fellows perceive the importance of assessing psychosocial risk factors in adolescent rheumatology patients but have difficulty completing a full assessment due to lack of time and uncertainty of what to do with a positive screen. In particular, fellows are least likely to ask patients about SOGI information. Potential strategies to overcome barriers include enhanced adolescent and LGBTQ health-related training for pediatric rheumatologists, standardized screening practices, and integration of multidisciplinary teams to develop an algorithm for referral services for positive screens.

Figure 1. Frequency of pediatric rheumatology fellows performing a full HEADSS assessment and individual components of the HEADSS assessment on adolescent patients. Components of the HEADSS assessment are ranked by mean Likert score for frequency (range 0-3), as well as the proportion of responses for each frequency rating (0 = never, 1 = sometimes, 2 = often, 3 = very often).

Figure 2. Barriers to performing a HEADSS assessment and collecting SOGI data as perceived by pediatric rheumatology fellows. Perceived barriers are ranked by mean Likert score for degree of perceived barrier (range 0-3), as well as the proportion of responses for each degree of perceived barrier rating (0 = not a barrier, 1 = minimal barrier, 2 = moderate barrier, 3 = severe barrier).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/identifying-targets-to-improve-the-assessment-of-psychosocial-risk-factors-in-adolescent-patients-perspectives-from-pediatric-rheumatology-fellows-in-the-united-states-and-canada/