Improving Depression Screening in Pediatric Sub-Specialty Clinics

Learning objective: Evaluate how education and a pre-implementation survey to identify screening barriers may affect universal depression screening outcomes in three pediatric sub-specialty clinics.
Background: Half of all mental health issues develop by age 14 years. Depression affects about 1 in 4 children. Guidelines from the United States Preventative Services Task Force2 and the American Academy of Pediatrics recommend annual universal depression screening of adolescent patients ages 12 years and older for major depressive disorder with a formal self-report screening tool either on paper or electronically. Both screening for depression and referral to mental health providers continue to be issues in pediatric populations.
Purpose: Evaluate the effect of an educational intervention and a pre-implementation survey focused on screening barriers on universal depression screening outcomes in pediatric sub-specialty clinics.
Methods: Universal depression screening was implemented at least annually for children aged 12 to 17 years using the PHQ-A with a screening score of >10 (moderate depressive symptoms or greater) in our adolescent medicine (AM), cardiology (PC), and medical specialty (PMS) clinics between July 2023 and May 2024. One month before implementation, registered nursing staff in all clinics were educated about the depression screening process, outcomes, and follow-up process specific to each clinic. Before education, nurses in the PC clinic were sent an electronic survey to identify barriers and concerns about depression screening implementation. Education in the PC clinic also addressed concerns noted in the pre-education survey.
Screening process: Every age-appropriate child is screened as follows: 1) PC clinic: every visit, occurring every 6 months-3 years; 2) AM and PMS clinics: annual screening; 3) patients with a screening score of >10 are seen in all clinics by a social worker. The PC and PMS clinics give paper surveys to adolescents to complete, while the AM clinic uses an iPad for survey completion.
Outcomes: Outcomes are reported as a percentage of adolescents screened at baseline (in the month before screening education) and at 2-month intervals thereafter.
Evaluation/conclusions: All clinics experienced improvements in adolescent depression screening. The AM and PMS clinics had lower screening percentages of adolescents compared to the PC clinic. It is also possible that addressing concerns of the PC staff about depression screening and integrating this information into the PC education had a significant positive result on PC screening outcomes.