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Assessing the Impact of a Web-Based Comprehensive Somatic and Mental Health Screening Tool in Pediatric Primary Care

      Abstract

      Objective

      To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit.

      Methods

      A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented for a well-child visit with a child 4 to 10 years of age. Parents completed an electronic previsit screen, which included somatic concerns, health risks, and 4 mental health tools (SCARED5, PHQ-2, SDQ Impact, and PSC-17). Parents completed an exit survey, and a subset were interviewed. All primary care providers (PCPs) were interviewed.

      Results

      A total of 120 parents and 16 PCPs participated. The exit surveys showed that nearly 90% of parents agreed or strongly agreed that the screener was easy to use and maintained confidentiality. During interviews, parents noted that the screener helped with recall, validated concerns, reframed issues they thought might not be appropriate for primary care, and raised new questions. PCPs thought that the screener enabled them to normalize sensitive issues, and it permitted them to simultaneously focus and be comprehensive during the visit. Parents and PCPs agreed that the screener helped guide discussion, promoted in-depth exchange, and increased efficiency. Findings were consistent across quantitative and qualitative methods and between parents and PCPs.

      Conclusions

      A comprehensive electronic previsit screening tool is an acceptable and practical strategy to facilitate well-child visits. It may help with problem identification as well as with setting agendas, engaging the family, and balancing attention between somatic and psychosocial concerns.

      Keywords

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      References

        • Bingham R.L.
        • Plante D.A.
        • Bronson D.L.
        • et al.
        Establishing a quality improvement process for identification of psychosocial problems in a primary care practice.
        J Gen Intern Med. 1990; 5: 342-346
        • Brugman E.
        • Reijneveld S.
        • Verhulst F.
        • Verloove-Vanhorick S.P.
        Identification and management of psychosocial problems by preventive child health care.
        Arch Pediatr Adolesc Med. 2001; 155: 462-469
        • Fein J.A.
        • Pailler M.E.
        • Barg F.K.
        • et al.
        Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department.
        Arch Pediatr Adolesc Med. 2010; 164: 1112-1117
        • Ford D.E.
        • Kamerow D.B.
        Screening for psychiatric and substance abuse disorders in clinical practice.
        J Gen Intern Med. 1990; 5: S37-S41
        • Kemper K.J.
        Self-administered questionnaire for psychosocial screening in pediatrics.
        Pediatrics. 1992; 89: 433-436
        • Murphy J.M.
        • Arnett H.L.
        • Bishop S.J.
        • et al.
        Screening for psychosocial dysfunction in pediatric practice: a naturalistic study of the Pediatric Symptom Checklist.
        Clin Pediatr. 1992; 31: 660-667
        • Brown J.D.
        • Wissow L.S.
        Screening to identify mental health problems in pediatric primary care: considerations for practice.
        Int J Psychiatry Med. 2010; 40: 1-19
        • Diamond G.
        • Levy S.
        • Bevans K.
        • et al.
        Development, validation, and utility of Internet-based, behavioral health screen for adolescents.
        Pediatrics. 2010; 126: e163
        • Hacker K.
        • Myagmarjav E.
        • Harris V.
        • et al.
        Mental health screening in pediatric practice: factors related to positive screens and the contribution of parental/personal concern.
        Pediatrics. 2006; 126: 1896
        • Halfon N.
        • Stevens G.D.
        • Larson K.
        • Olson L.M.
        Duration of a well-child visit: association with content, family-centeredness, and satisfaction.
        Pediatrics. 2012; 128: 657-664
        • Olson A.L.
        • Kelleher K.J.
        • Kemper K.J.
        • et al.
        Primary care pediatricians’ roles and perceived responsibilities in the identification and management of depression in children and adolescents.
        Ambul Pediatr. 2001; 1: 91-98
        • Weitzman C.C.
        • Leventhal J.M.
        Screening for behavioral health problems in primary care.
        Curr Opin Pediatr. 2006; 18: 641-648
        • Gans Epner J.E.
        • Levenberg P.B.
        • Schoeny M.E.
        Primary care providers’ responsiveness to health-risk behaviors reported by adolescent patients.
        Arch Pedatr Adolesc Med. 1998; 152: 774-780
        • Gadomski A.
        • Bennett S.
        • Young M.
        • Wissow L.S.
        Guidelines for adolescent preventive services: the GAPS in practice.
        Arch Pediatr Adolesc Med. 2003; 157: 426-432
        • Klein J.D.
        • Allan M.J.
        • Elster A.B.
        • et al.
        Improving adolescent preventive care in community health centers.
        Pediatrics. 2001; 107: 318-327
        • O’Connor M.
        • Felt B.
        Do parent questionnaires promote pediatrician discussion of behavioral issues at routine health care visits?.
        Arch Pediatr Adolesc Med. 1994; 148: 35
        • Schubiner H.
        • Tzelepis A.
        • Wright K.
        • Podany E.
        The clinical utility of the Safe Times Questionnaire.
        J Adolesc Health. 1994; 15: 374-382
        • Zuckerbrot R.A.
        • Maxon L.
        • Pagar D.
        • et al.
        Adolescent depression screening in primary care: feasibility and acceptance.
        Pediatrics. 2007; 119: 101
        • Kurth A.E.
        • Martin D.P.
        • Golden M.R.
        • et al.
        A comparison between audio computer-assisted self interviews and clinician interviews for obtaining the sexual history.
        Sex Transm Dis. 2004; 31: 719-726
        • Olson A.L.
        • Gaffney C.A.
        • Hedberg V.A.
        • Gladstone G.R.
        Use of inexpensive technology to enhance adolescent health screening and counseling.
        Arch Pediatr Adolesc Med. 2009; 163: 172-177
        • Olson A.L.
        • Gaffney C.A.
        • Hedberg V.A.
        • et al.
        The Healthy Teen Project: tools to enhance adolescent health counseling.
        Ann Fam Med. 2005; 3: S63-S65
        • Chisolm D.J.
        • Gardner W.
        • Julian T.
        • Kelleher K.J.
        Adolescent satisfaction with computer-assisted behavioural risk screening in primary care.
        Child Adolesc Ment Health. 2008; 13: 163-168
        • Anand V.
        • Carroll A.E.
        • Downs S.M.
        Automated primary care screening in pediatric waiting rooms.
        Pediatrics. 2012; 129: e1275-e1281
        • Horwitz S.M.
        • Hoagwood K.E.
        • Garner A.
        • et al.
        No technological innovation is a panacea: a case series in quality improvement for primary care mental health services.
        Clin Pediatr (Phila). 2008; 47: 685-692
        • John R.
        • Buschman P.
        • Chaszar M.
        • et al.
        Development and evaluation of a PDA-based decision support system for pediatric depression screening.
        Stud Health Technol Inform. 2007; 129: 1382-1386
        • Berger-Jenkins E.
        • McCord M.
        • Gallagher T.
        • Olfson M.
        Effect of routine mental health screening in a low-resource pediatric primary care population.
        Clin Pediatr. 2012; 51: 359-365
      1. Hagan J.F. Shaw J.S. Duncan P.M. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd ed. American Academy of Pediatrics, Elk Grove Village, Ill2008
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.W.
        The Patient Health Questionnaire-2: validity of a two-item depression screener.
        Med Care. 2003; 41: 1284-1292
        • Pignone M.
        • Gaynes B.
        • Rushton J.
        • et al.
        Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force.
        Ann Intern Med. 2002; 136: 765-776
        • Jellinek M.S.
        • Murphy J.M.
        • Little M.
        • et al.
        Use of the pediatric symptom checklist to screen for psychosocial problems in pediatric primary care: a national feasibility study.
        Arch Pediatr Adolesc Med. 1999; 153: 254-260
        • Goodman R.
        The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden.
        J Child Psychol Psychiatry. 1999; 40: 791-799
        • Birmaher B.
        • Brent D.A.
        • Chiappetta L.
        • et al.
        Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study.
        J Am Acad Child Adolesc Psychiatry. 1999; 38: 1230-1236
        • Boyatzis R.E.
        Transforming Qualitative Information: Thematic Analysis and Code Development.
        Sage, Thousand Oaks, Calif1998
        • Pailler M.E.
        • Cronholm P.F.
        • Barg F.K.
        • et al.
        Patients’ and caregivers’ beliefs about depression screening and referral in the emergency department.
        Pediatr Emerg Care. 2009; 25: 721-727
        • Sarvet B.
        • Gold J.
        • Straus J.H.
        Bridging the divide between child psychiatry and primary care: the use of telephone consultation within a population-based collaborative system.
        Child Adolesc Psychiatr Clin N Am. 2011; 20: 41-53
        • Hilt R.J.
        • Romaire M.A.
        • McDonnell M.G.
        • et al.
        The Partnership Access Line: evaluating a child psychiatry consult program in Washington State.
        JAMA Pediatr. 2013; 167: 162-168