INNOVATION FUND The Future of Academic Medicine New Technology, Therapies, eHealth & mHealth SHOWCASE 2023

Validation of the HEADS-ED for use with pediatric mental health patients in the emergency department

New Technology, Therapies, eHealth & mHealth

Clare Gray

613-737-7600 x 2683


CHAMO (Children’s Hospital Academic Medical Organization)
CHEO (Children’s Hospital of Eastern Ontario)
UOttawa (University of Ottawa)


We developed the HEADS-ED, an easy-to-use screening tool that physicians can use during a visit to the Emergency Department to help identify mental health and addictions needs in children and youth and aid in taking a psychosocial history. This study provided the data to support the psychometric properties of the HEADS-ED. The study showed that the HEADS-ED could be used in ED decision-making for pediatric patients with mental health concerns.

The HEADS-ED is now utilized in many settings including walk in clinics (One Stop Talk (Provincial Mental Health Program)), primary care pathways (6 sites in Ontario); intake services (1call1click, IWK), ED services (CHEO) and in further research projects.


Objective: To validate the HEADS-ED screening tool for use with pediatric patients in the Emergency Department.
Methods/Results: A total of 313 patients were included, mean age was 14.3 (SD 2.63), and there were 182 females (58.1%). Interrater reliability was 0.785 (P < .001). Correlations were computed for each HEADS-ED category and items from the CANS MH and the CDI. Correlations ranged from r = 0.17, P < .05 to r = 0.89, P < .000. The HEADS-ED also predicted psychiatric consult and admission to inpatient psychiatry (sensitivity of 82% and specificity of 87%)
Conclusion: Results provided evidence to support the psychometric properties of the HEADS-ED.
Next steps: This study led to the development of the HEADS-ED website (now supported by the Knowledge Institute on Child and Youth Mental and Addictions and the CHEO Research Institute). In addition, the HEADS-ED has been widely implemented in different settings across Ontario and beyond. Highlights include the HEADS-ED being utilized within the Provincial Council for Child and Maternal Health (PCMCH) Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions. In 2019, the HEADS-ED was included in the Critical Crossroads Pediatric Mental Health Care in the Emergency Department: A Care Pathway Resource Toolkit. Rockville, Maryland: U.S. Department of Health and Human Services, 2019
We have also evaluated utilization of HEADS ED in the primary care setting (Cappelli, M., Motamedi, F., Gray, C., Cloutier, P. (Feb, 2019). From Screening to Services: Integrating the HEADS-ED Mental Health Screening Tool into Primary Care. University of Ottawa Brain and Mind Research Institute, $35,000 (2019-2020)) and we have expanded the HEADS-ED to a different age group (under the age of 6).


Complete listing of 24 publications available at under the Research tab
Cappelli M, Gray C, Zemek R, Cloutier P, Kennedy A, Glennie E, et al. The HEADS-ED: a rapid mental health screening tool for pediatric patients in the Emergency Department. Pediatrics. 2012 Aug;130(2):e321-7. Doi:10.1542/peds.2001.3798

Cappelli M, Zemek R, Polihronis C, Thibedeau N, Kennedy A, Gray C, et al. The HEADS-ED: Evaluating the Clinical Use of a Brief Action-Oriented Pediatric Mental Health Screening Tool. Pediatric Emergency Care. 2017 doi: 10.1097/pec.0000000000001180

MacWilliams K, Curran J, Racek J, Cloutier P & Cappelli M. Barriers and Facilitators to Implementing the HEADS-ED: A Rapid Screening Tool for Pediatric Patients. Pediatric Emergency Care. 2017. 33(12), 774-780. Doi: 10.1097/pec.0000000000000651

Jabbour M, Hawkins J, Day D, Cloutier P, Polihronis C, Cappelli M, et al. An Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions. Child and Adolescent Psychiatric Clinics of North America 27(3), 413-425.

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