P3.C055: PHQ-A Integration Initiative: Enhancing Adolescent Behavioral Health Screening within a Federally Qualified Health (FQHC) System

Background: Utilizing the PHQ-9 Modified for Adolescents (PHQ-A) is the validated, gold standard tool for screening and early intervention of depression in this population (Lovero et al., 2022). Of concern, there was a rise in mental health challenges among adolescents in which 20.1% of those aged 12-17 had experienced at least one Major Depressive Episode in 2021 (SAMHSA, 2022). Given this context, Downey John Wesley County Hospital (JWCH) strives to champion pediatric behavioral health. In 2023, JWCH screened 3852 adolescents aged 12-17 without prior diagnosis of depression or bipolar disorder, constituting 12% of their total behavioral health screenings. Within a FQHC system, like JWCH Downey, accurate evaluation of behavioral health can be impeded by systemic issues within the Electronic Medical Record (EMR) system and inefficient workflow, leading to gaps in effective preventative health care.

Project Description: Our partnership with the clinic since November 2022 aimed to facilitate the electronic implementation of PHQ-A template into the NextGen EMR system to enhance workflow and improve behavioral health capture for JWCH's Healthcare Effectiveness Data and Information (HEDIS) measures. Collaborating with the clinic director, we identified that Medical Assistants manually input PHQ-A data from paper forms into the EMR’s PHQ-9 template, effectively miscapturing suicidality. To implement this system-wide change, we garnered support from the Chief of Psychiatry and Chief Medical Officer and collaborated closely with the Informational Technology team. We then hosted a training on the new workflow at Downey JWCH with an infographic detailing how this change would be operationalized. Data collection and statistical analysis of this EMR change is ongoing.

Discussion: Implementing the PHQ-A as the gold standard for adolescent depression screening underscores its clinical importance; however, our experience at Downey JWCH highlighted significant systemic barriers in integrating this tool within an EMR system not fully designed to accommodate it. This misalignment exacerbated the workload on pediatric care teams in an FQHC already stretched thin. Our project, set against this backdrop, serves as a case study in leveraging technology to enhance clinical workflows and data accuracy, thereby contributing to more effective preventative care for adolescents. This initiative is limited by the potential for technological glitches and the need for ongoing training for healthcare staff, which may temporarily disrupt clinical workflow.

Conclusion: The successful integration of the PHQ-A into the NextGen EMR system at Downey JWCH marks a pivotal achievement in pediatric behavioral health, optimizing screening processes and elevating the precision of HEDIS metrics for enhanced patient care. This effort not only facilitates immediate improvements in healthcare delivery but also sets a precedent for future studies and advocacy projects aiming to bridge technological and systemic gaps that may remain latent in pediatric mental health services, specifically in resource-stressed environments like FQHCs.