Success Story

Improve survey response rates, data quality and workflow with a Digital HEADSS Assessment using Digital Empathy


Many young people with chronic illnesses have an increased risk of mental health problems due to stigma, sub-optimal self-care and disengagement from health services.

Psychosocial screening for this particular group of youth is paramount, and the HEADSS framework has been widely used to identify areas for concern in this population. The HEADSS (Home environment, Education/employment, Eating, peer related Activities, Drugs, Sexuality, Suicide/depression, and Safety) assessment is a practical, time-tested strategy that guides semi-structured interviewing on psychosocial factors that impact an adolescent’s well-being. Tickit® offers a low literacy, digital commercialized format of the HEADSS assessment.

Trapeze is the specialist adolescent chronic care service for The Sydney Children’s Hospitals Network in NSW, Australia. Founded in 2012, Trapeze was created to support young people from ages 14 – 25 to manage their conditions better, to improve outcomes and reduce emergency visits and hospital admissions.

Woman using Digital Empathy screener tool HEADSS

Challenges with traditional collection methods of Patient Reported Data:

  • Collecting data can be impersonal
  • There is a stigma around many of the topics being discussed
  • Survey time is long and has a negative effect on hospital workflow
  • Risk of missing vital signs and information


Prior to connecting with Tickit Health, Administering surveys increased the burden on providers who were already short on time.

Prior to connecting with Tickit Health, the Trapeze clinic tried various methods to administer the HEADSS assessment and repeatedly faced a common challenge: administering the surveys increased the burden on providers who were already short on time. They attempted to administer the survey over the phone before a patient’s appointment, but this did not improve efficiencies nor did it provide added benefit to the patient.

A secondary problem was the inherent challenges with traditional paper-based data collection such as user fatigue, fragmented experiences, barriers with cultural and literacy levels, and young people simply find surveys a chore to complete.


Tickit® was brought in to apply Digital Empathy and digitize the survey to address challenges in patient experience and hospital workflow.

The decision to use Tickit included the Digitally Empathetic youth-friendly user interface (colourful graphics, non-judgmental, gender neutral), low literacy level, and previous evidence regarding its acceptability as a data collection tool. As well, the data standardization and stratification (with risk and protective factors highlighted) and live data access would make data review fast and simple.

HEADSS Digital Empathy

Figure 1. Tablet Survey Interface Youth friendly graphics increase response rate and contribute to reducing stigma


This study compared data collected from the digital questionnaire Tickit®, to data recorded in the hospital Electronic Medical Record (EMR) after a face-to-face HEADSS interview, in order to understand the relative benefits and drawbacks of the two methods with regard to data collection, data quality and time efficiency; all core quality of care metrics

Review Study 1Review Study 2

Young people (n=146) aged 14-25 years enrolled in Trapeze, an adolescent chronic care and transition service, were recruited for this study. They received a face-to-face interview and at the same visit they completed Tickit® using an iPad.

A panel of 4 clinician experts determined 29 significant data validation points for comparison between Tickit® and the EMR. Following the framework that Tickit® used to categorize questions, category averages were calculated for both the Tickit® data and the data extracted from EMR for further analysis.

Data validation points covered the Tickit® categories:
Home, Education, Eating, Emotions, Activities, Demographics, Drugs and health, Sexual activity, Sexuality, Sleep, Screen use, Safety

Figure 2. Wilcoxon Signed Rank Test Compares category averages for the Tickit® assessment and the HEADSS guided initial assessment (p<0.01).


  • The Digital HEADSS Assessment using Digital Empathy identified critical data previously missed in regular practice and person-person administration of the HEADSS assessment.
  • Tickit data outperformed the traditional paper assessment in both quality and quantity of responses.
  • The hospital saw significant workflow improvements with the ability to administer the survey without the need for a clinician-guided interview, as well as shortened survey completion time.
  • Tickit data enabled clinicians to provide better care with the increase in survey response rates and improved collection for sensitive topics with poor uptake using traditional methods.

Conclusions & Impact

User-friendly Digital Empathy for survey, assessment, and questionnaire design has clear benefits for the effective collection of sensitive data. This finding is further supported in a systematic review conducted by Drs. Bradford and Rickwood who found that adolescents preferred a self-administered tool over a face-to-face interview. The review also identified e-tools as a way to positively engage young people uncomfortable with interpersonal communication, reach those who have difficulty articulating their thoughts, and increase their perception of confidentiality when disclosing sensitive information.  

There are clear advantages to electronic psychosocial surveys for adolescents. Of particular value is the ability to consistently extract and record comprehensive sensitive data from young people in a short period of time.

Their network has expanded across Canada to include over 12,000 employees, 100 offices, 70 clinics and 13 pharmacies – delivering services in local communities.

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