Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Controlled Trial

Background: Psychosocial problems such as depression, anxiety, and
substance abuse are common and burdensome in young people. In New
Zealand, screening for such problems is undertaken routinely only
with year 9 students in low-decile schools and opportunistically in
pediatric settings using a nonvalidated and time-consuming
clinician-administered Home, Education, Eating, Activities, Drugs
and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS)
interview. The Youth version, Case-finding and Help Assessment Tool
(YouthCHAT) is a relatively new, locally developed, electronic
tablet–based composite screener for identifying similar
psychosocial issues to HEEADSSS Objective: This study aimed to
compare the performance and acceptability of YouthCHAT with
face-to-face HEEADSSS assessment among 13-year-old high school
students. Methods: A counterbalanced randomized trial of YouthCHAT
screening either before or after face-to-face HEEADSSS assessment
was undertaken with 129 13-year-old New Zealand high school
students of predominantly Māori and Pacific Island ethnicity. Main
outcome measures were comparability of YouthCHAT and HEEADSSS
completion times, detection rates, and acceptability to students
and school nurses. Results: YouthCHAT screening was more than twice
as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min;
mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min
10 seconds]; P<.01) and detected more issues overall on
comparable domains. For substance misuse and problems at home, both
instruments were roughly comparable. YouthCHAT detected
significantly more problems with eating or body image perception
(70/110, 63.6% vs 25/110, 22.7%; P<.01), s****l health (24/110,
21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110,
15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110,
19.1%; P<.01). HEEADSSS had a greater rate of detection for a
broader set of mental health issues (30/110, 27%) than YouthCHAT
(11/110, 10%; P=.001), which only assessed clinically relevant
anxiety and depression. Assessment order made no significant
difference to the duration of assessment or to the rates of
YouthCHAT-detected positive screens for anxiety and depression.
There were no significant differences in student acceptability
survey results between the two assessments. Nurses identified that
students found YouthCHAT easy to answer and that it helped students
answer face-to-face questions, especially those of a sensitive
nature. Difficulties encountered with YouthCHAT included occasional
Wi-Fi connectivity and student literacy issues. Conclusions: This
study provides preliminary evidence regarding the shorter
administration time, detection rates, and acceptability of
YouthCHAT as a school-based psychosocial screener for young people.
Although further research is needed to confirm its effectiveness in
other age and ethnic groups, YouthCHAT shows promise for aiding
earlier identification and treatment of common psychosocial
problems in young people, including possible use as part of an
annual, school-based, holistic health check. Clinical Trial:
Australian New Zealand Clinical Trials Network Registry (ACTRN)

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Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Controlled Trial