QUALITY IMPROVEMENT PROJECT FOR ADOLESCENT MENTAL HEALTH THROUGH TABLET-BASED SCREENING

BACKGROUND: About 20% of adolescents have had one major depressive episode, with 59% of them not receiving treatment. About 32% of adolescents have an anxiety disorder, with 8% experiencing severe impact from it. Screening for adolescent depression and anxiety is recommended by the American Academy of Pediatrics and the United States Preventative Services Task Force (USPSTF). At the University of North Carolina (UNC) Adolescent Specialty Care Clinic (ASCC), screening is an already established process; however, a strategic goal was to transition paper-based screenings to tablet-based screenings (TBS).METHODS: This quality improvement (QI) initiative sought to transition the mental health screenings of the PHQ-SADS and the EAT-26 that were used in the ASCC from paper-based to TBS to provide benefits to the healthcare team using quality improvement methodologies, chart audits, and surveys to assess the success and benefits of TBS. Through standardization and electronic medical record integration (EMR) and modification, TBS was introduced. Quality improvement methodologies of key stakeholder interviews, process mapping, plan-do-study-act (PDSA) cycles, and real-time data feedback guided the implementation. Education using multiple methods, such as one-on-one training and tip sheets, improved adherence to the process. RESULTS: TBS occurred 50-91% of the time. Possible barriers to TBS included the legal limitations of the mental health screeners, limited tablets, and the change of process that interrupted the usual process flow. Survey results found staff to be favorable towards the change, with 100% of respondents being “definitely satisfied” with the process change and 80% believing it was useful, saved time, improved appointment flow, helped documentation to be more timely and complete, and will be a sustained change.CONCLUSION: TBS was found to be beneficial to healthcare providers to increase provider satisfaction around screening, decrease documentation burden, and streamline appointments. TBS may have issues related to limited resources or the legality of using electronic screening forms for sensitive screeners. TBS can not only address the growing adolescent mental health crisis but also address burdens providers experience in documentation burden.