Pediatric Provider Experiences with Implementation of Routine Mental Health Screening

Abstract

Objective: Despite the utility of universal screening, most pediatric providers rarely use mental health (MH) screening tools. As such, provider descriptions of their experiences with universal screening are limited. The goal of this study was to describe barriers to, and facilitators of, universal MH screening implementation, the perceived impact of such screening, impressions of a screening-focused quality improvement (QI) Learning Collaborative, and lessons learned. Method: We invited primary care clinicians participating in a large-scale QI Learning Collaborative on MH screening (n = 107) to complete postproject interviews. Interviews were transcribed and analyzed using constant comparative qualitative analysis, an inductive, iterative process. Results: Eleven interviews were completed and analyzed. Practice sites included academic health centers, a private practice, and a federally qualified health center. Providers described the positive impact of screening (increased identification of MH concerns) and barriers and facilitators of screening at the practice level (clinic and leadership buy-in and electronic medical record integration), the provider level (provider beliefs about the importance of screening), and the patient level (parent literacy). Challenges of linking families with care after screening included lack of adequate referrals, long wait lists, limited bilingual providers, insurance gaps, and inadequate feedback loops. Access to on-site MH clinicians and participation in the Learning Collaborative were described as beneficial. Conclusion: Findings elucidate how universal MH screening can be sustainably integrated into real-world primary care settings and may facilitate the uptake of American Academy of Pediatrics recommendations for best practices in screening for MH concerns.

Implementation of child-centred outcome measures in routine paediatric healthcare practice: a systematic review

“…Supervisees commented that supervisors used PROMs to a greater extent after training. Supervisees commented that supervisors were more confident in their use of PROMs in supervision Gerhardt (2018); USA; Case Report [ 56 ] To describe the development and implementation of a PRO program at Cincinnati Children’s Hospital Medical Centre that can serve as a standardized approach for the use of PROs in a clinical setting N = n/a ; Tertiary Hospital; children unspecified; multiple condition groups including: asthma, allergy, Autism, diabetes, anxiety, cardiology, nephrology, depression 26 Generic PRO Instruments (covering emotional health, behavioural health, social health, physical health, overall health (PedsQL), and care management)/42 disease-specific PRO instruments; child self-report and parent-proxy measures included Components identified as essential to successful PRO implementation: Commitment (Identification of a committed clinical team leader and team)‚ Instrument Selection (Selection of an instrument that addresses the identified outcome of interest), Scores (specification of threshold scores that indicate when an intervention is needed), Interventions (identification of clinical interventions to be triggered by threshold scores), Training (training for providers and staff involved in the PRO implementation process—Trained staff ensures continued use), Reliability and Use (Measurement and monitoring for PRO reliability and use—Too many questions is too burdensome) Godoy (2021); USA; Qualitative Research [ 57 ] To describe barriers to, and facilitators of, universal MH screening implementation, the perceived impact of such screening, impressions of a screening-focused QI Learning Collaborative, and lessons learned N = 11 ; Primary Care; 3 moths-18 years; mental health ASQ:SE/SDQ/PHQ-9; child and parent proxy completion; administered by PCCs in well-child visits Provider capacities/characteristics that facilitated implementation included factors such as PCC knowledge, understanding, attitudes, and confidence related to identifying and addressing mental health (MH) issues. Patient capacities/characteristics that acted as barriers to successful screening and referral included language, literacy, and parent motivation, previous child and family experiences of mental health issues, and the family’s ability to navigate resources Harding (2019); UK; Qualitative [ 76 ] To elicit views on the domains/items to include in a PCOM, implementation challenges and requirements for use in routine care by practitioners N = 36 ; Tertiary Hospital/Community; paediatric unspecified; Life Limiting Conditions/Life Threatening Illness N/A Measures should be able to be used by CYP with a wide range of cognitive abilities and also demonstrate proxy validity and responsiveness.…”

“…With respect to study design, n = 17 studies used mixed methods [ 58 , 65 , 72 , 75 , 79 , 82 , 86 , 89 , 90 , 95 , 99 , 100 , 102 , 103 , 106 , 107 , 109 , 110 ]; n = 15 studies used qualitative methods [ 46 , 52 , 55 , 57 , 60 , 67 , 70 , 76 , 78 , 80 , 91 , 93 , 94 , 105 , 108 ]. N = 12 studies were non-randomised experimental studies [ 44 , 54 , 61 , 68 , 69 , 71 , 77 , 81 , 85 , 92 , 96 , 101 ], and n = 12 were quality improvement projects [ 42 , 43 , 45 , 47 – 49 , 51 , 53 , 62 – 64 , 98 ].…”

“…A further n = 2 articles reported on studies conducted across secondary mental health care settings and the community [ 65 , 77 ]. There were n = 12 articles reporting on studies conducted in primary care settings [ 42 , 43 , 45 , 49 , 53 , 57 , 64 , 67 , 71 , 99 , 100 , 107 , 109 ], and n = 2 articles reported on studies conducted across primary care and community settings [ 48 , 55 ]. N = 2 articles reported on studies took place solely in the community [ 78 , 108 ] and n = 1 took place across multiple settings, but did not specify details [ 83 ].…”

“…Intervention source [ 18 , 83 , 87 , 99 ] Stakeholders’ perception of the source of the PCOM—whether it has been developed internally or externally 4 (5.8) B. Evidence strength and quality [ 50 , 55 , 70 , 73 , 92 , 97 ] Stakeholders’ perception of the strength of the evidence supporting the belief that the use of a new PCOM will have the desired outcomes e.g., improve care 6 (8.7) C. Relative advantage [ 44 – 46 , 48 – 50 , 53 – 56 , 61 , 62 , 64 , 65 , 69 , 70 , 72 , 79 , 80 , 82 , 83 , 85 , 89 – 91 , 93 , 100 , 103 , 105 , 106 , 108 , 110 ] Whether stakeholders perceive a new PCOMS as advantageous over current practice 31 (44.9) D. Adaptability [ 42 , 52 , 55 , 57 , 72 , 78 , 94 , 100 , 106 , 108...…”

From planning to implementation: Creating and adapting universal screening protocols to address caregiver mental health and psychosocial complexity.

“…The key aspects include buy-in and active support from leadership for universal screening, thorough review of logistical details from how screeners are administered to who responds to screeners, initial clinic teaching sessions for screening processes with continued implementation support over time, and communication among care team members about screening results to inform clinical care and collaboration. Pediatric primary care providers recognize the positive impact of screening for behavioral health, importance of multi-stakeholder buy-in, and challenges in providing referrals and establishing collaboration with behavioral health providers (Godoy et al, 2020).…”