P2.P301: Rising to Screening Guidelines: A Pediatric Mental Health Quality Improvement Project

Purpose/Objectives: The objective is to improve mental health screening documentation by 25% from baseline at age-appropriate well child visits consistent with AAP guidelines in two academic clinics.

Design/Methods: This study followed a PDSA (Plan-Do-Study-Act) format. At baseline, no anxiety screening was performed, trauma screening using ACE-Q was performed for ages 1+, and depression screening using PHQ-9 was being performed for ages 12+. Data was collected from two resident clinics (Clinics A and B). Clinic guidelines were adjusted and standardized: GAD7 for anxiety at ages 8+; PHQ-9 for depression at ages 12+; ACE-Q or Pediatric Integrated Post-Trauma Services (PIPS) at ages 1-5 years old and ages 6+, respectively. Baseline data was collected in August 2023, and five cycles were completed in September, October, December, January, and February. One week of chart data for well-child checks was randomly collected each cycle and analyzed for average completion rates. In the first cycle, faculty and residents were educated on screening guidelines. In the second, note templates were updated. In the third, faculty, staff, and residents were reeducated on screeners; an IT circumstance preventing note template use was discovered for Clinic B. Note templates were adjusted in the fourth and fifth cycles and faculty were reinformed about when to complete screeners if their screener use was not according to guidelines.

Results: Baseline data showed 0% completion for anxiety screeners, 44% for trauma, and 95% for depression. Anxiety screening improved to 61.9% completion, and trauma to 80% across both clinics. Since depression screening was already in place, it was used as a balancing measure and varied across PDSA cycles – overall declining to 80% completion. In total, 806 patient encounters were analyzed, 356 at Clinic A and 450 at Clinic B.

Conclusion/Discussion: While combined data shows improvements in anxiety and trauma screening compliance, there has been a decline in depression screening. It is unclear whether this is due to increased provider burden, providers being unaware of appropriate guidelines, or front desk miscommunication. There is also a disproportionate number of visits for adolescents 12 and up, accounting for only 14.7% of all visits measured, leading to increased impact of a few screeners being missed. There is also a significant disparity between the two clinics being studied in all categories which may be attributed to differences in the documentation templates, with Clinic A performing better in almost all instances of data collection, warranting further investigation into differences in provider education, documentation, or clinic workflow. Overall data trends across the first PDSA cycles are promising for anxiety and trauma screening. Further PDSAs aim to emphasize implementation of flowcharts and well-placed visual aids to further remind providers of screeners, as well as positive and negative reinforcement to providers who are working at both clinics.