Improving adolescent psychosocial assessment through standardized patient simulation: An interdisciplinary quality initiative

Prevention of adolescent suicide is possible with early recognition of risk factors; however, many healthcare professionals lack necessary skills to interact effectively with adolescents due to insufficient training in residency. Supplementing traditional clinical experiences with communication focused education utilizing standardized adolescent patients (SP) has proven promising. This interdisciplinary quality initiative (QI) piloted an SP program informed by the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEEADSSS) interviewing process within the physician and nursing residencies of a South Texas pediatric tertiary care center to improve early identification of modifiable risk factors of suicidality among adolescent patients. Thirty-six residents participated in a program comprised of a 45-minute self-study module and a two-hour SP simulation session incorporating adolescent psychosocial interviews with individualized feedback and guided group reflection. Results of the one-group, pretest-posttest QI were favorable. A 13% increase in self-efficacy (M = 8.64, SD = 0.65), p =<.001, d = -1.79, 11% increase in competence (M = 55.83, SD = 7.58), p =<.001., d = -0.56, 17% increase in HEEADSSS use in practice (M = 2.55, SD = 0.69), p = 0.02, rrb = -1, and 89% increase in social work referrals for adolescents presenting with chief complaints not related to mental health were observed. While these improvements satisfied only one of the project’s aims fully, the clinically significant findings are encouraging and warrant the formal incorporation of the adolescent SP program into residency curriculums along with the exploration of utilizing SP methodology within other QI throughout the organization.