Literature Collection

INTRODUCTION: Screening for depression in caregivers of children with developmental disabilities is not routine, representing missed opportunities for support. METHOD: A quality improvement project was initiated in our pediatric clinic. Root causes of limited screening included unclear guidelines for support, caregiver perception that help is unavailable, and lack of a quick screening tool. A clinical pathway was constructed and integrated into existing practice using quality improvement methodology. RESULTS: Baseline screening rate was 5%-10%. During the 12-week pilot, weekly rates ranged from 46.0% to 91.0% (mean 70.2%). Monthly rates subsequently averaged 55.0%. Approximately 20% had a positive screen; over half were caregivers of children with autism. About 5% had moderate depression, of whom 40% required referral to social workers. DISCUSSION: Structured depression screening of caregivers of children with developmental disabilities is feasible and sustainable in a busy clinic. Further research is needed to measure the impact on child and family outcomes.

OBJECTIVE: This study aimed to assess the feasibility of the screening for early emerging mental experiences model, which is designed to screen for psychosis in settings with integrated primary and mental health care. METHODS: Psychosis screening, triage, and engagement processes (July 2021-June 2022) were implemented in four integrated care practices serving approximately 7,000 patients in the targeted age range (14-26 years). Practice and community stakeholders participated in the project's design and development. Psychosis care specialists provided training and case consultation to general medical providers and behavioral health clinicians (BHCs). The BHCs screened all patients referred for selective screening. One practice aimed to universally screen patients ages 14-26 attending well visits. RESULTS: Training sessions were attended by 100% (N=6) of the BHCs and by 79% (N=27 of 34) of the primary care providers. The BHCs selectively screened and triaged 266 patients (89% of their new patients). Providers conducted universal screening of 606 patients (67% of that site's well visits). The screening samples were >90% White and >55% rural, consistent with the clinics' populations. Rates of positive selective screens were consistent with published rates in similar populations. Of the recorded screening-related activities, 92% (146 of 159) were completed within the billable intake time, and 11% (N=17) of these patients were engaged in a psychosis-relevant discussion. The providers reported that the project was important and positive. CONCLUSIONS: Systematic assessment of psychosis symptoms, followed by triage and engagement, appeared to be feasible and acceptable to patients and providers in integrated care settings.