P2A049: Screening for Emotional and Behavioral Health Concerns and Eliciting Patient Strengths at All Well Child Checks: An Education and Emr-based Quality Improvement Initiative

Purpose/Objectives: The proportion of children diagnosed with mental health concerns has undergone significant increases over recent years. This resulting challenge has been identified by the Office of Disease Prevention and Health Promotion in their goals for “Healthy People 2030”. It focuses on prevention, screening and treatment of mental health care, strengthening of family relationships, in addition to timely access to health care and promotion of healthy habits. Consequently, the onus to address and manage these health concerns becomes the responsibility of the primary care office. Essential components of this care include screening for problems and using strength-based approaches for communication. At our academic center, we found varying rates regarding the elicitation and addressing the social, behavioral, and emotional concerns of parents and patients, as well as documentation of discussion regarding family and personal strengths. We aimed to increase these rates overall.

Design/Methods: Over six months, a team of two attending and three resident physicians led our clinic practice to pilot the incorporation of patient and family strengths into well-child check visits. Our clinic practice comprises 46 resident and 6 supervising attending physicians. This project was an initiative of the AAP ECHO mental health Quality Improvement collaborative. Using the Plan, Do, Study, Act (PDSA) methodology, multiple PDSAs were performed. Interventions fell into two categories: creating physician education sessions, and utilizing standardized note templates to prompt providers to ask these questions. We conducted monthly de-identified chart reviews of 20 encounters and entered into the Quality Improvement Data Aggregator (QIDA) system. We evaluated if there was documentation that concerns about behavioral/social/emotional health were elicited and addressed at routine well-child-visits and if the provider discussed patient/family strengths.

Results: At baseline, our providers’ documentation of elicitation and addressing behavioral/social concerns was 50%. Additionally, there was 0% documentation for eliciting patient/family strengths. Following the educational PDSAs, the rate of addressing such concerns increased to 87.5%, a 37.5% increase from the baseline. After changing standardized note templates, the rates of documentation of eliciting for strengths increased to 40%. Reminder just prior to the start of the clinic by supervising attending in a small group setting increased the compliance to 84%.

Conclusion/Discussion: Mental health integration in primary care is an essential tool to screen, assess and provide support in a timely manner. In addition to focused provider education on mental health care in pediatrics, the use of a standardized template helped increase the rates of conversations with family regarding patient strengths and improved patient-centered care. Additionally, the use of lead champion physicians who can provide one-on-one reminders resulted in the most significant rates of change.