December 4, 2014 | Tags: Blog | Tags: Rural , Eastern Oregon , Screening , Adolescents
Kate Barrett, a care coordinator at Winding Waters Clinic in Enterprise, OR, shares how they came to develop and implement a mental health screening process for teens.
Q: What inspired Winding Waters Clinic to develop a mental health screening process for teens?
We were inspired by an ECHO learning session regarding Integrating behavioral health into primary pediatric health care. This was an inspiring learning session with many parents of teens with behavioral health issues sharing their stories, and we knew we needed to do something to open the discussion among our teen patients. Our initial plan was to develop a one page screener to administer to teens that attend the sports physicals provided free of charge every spring at our clinic. It seemed like good timing as spring and summer are a tough time on teenagers in our tiny rural county, and we always lose a few to alcohol, drug and mental health-related issues each year.
Q: What are the most notable changes you have experienced since implementing the teen screening process?
We have been pleasantly surprised by the avenues of communication this small screener has opened. I don't think teens generally see their Primary Care Physician (PCP) as someone they can discuss these issues with, and when the door opened, the kids were amazingly forthcoming about what was going on in their lives. We have made huge strides with referrals to Behavioral Health Counseling, as well as birth control and alcohol and drug counseling. This small tool has changed the way we relate to our teen patients.
Q: What pushback, if any, have you experienced from parents?
We have not experienced push back from most of our parents. Our providers spend time with both the parent and the teen, and then ask the parent to wait in the waiting room while the teen fills out the screening tool and talks to the provider regarding the screener. Notable push back was mounted by the three local school districts who were originally OK with the screener being administered at the free sports physicals until one administrator decided it was a bad idea and whipped the rest into a frenzy of dissent. We opted to not give these at the sports physicals, which was disappointing because these physicals reach about 80% of the teens in our county. Some of those kids we will never have the chance to reach out to in any other manner. We still have hopes to incorporate this into future sports physicals, as mental health is as important as physical health to an athlete.
Q: How have your teen patients responded to the process?
I am not aware of any negative feedback from parents. Amazingly enough, many teens speak freely with their provider and then give their permission for the provider to discuss the issues with their parents. Other parents know there are problems that they are not effectively dealing with and are happy to let the providers have this discussion with their children.
Q: What steps did you take to develop these tools and process?
This screener is not really original. It is a compilation of three very common screening tools, a PHQ9 for adolescents, an adolescent SBIRT,and a HITS screener for domestic violence. The main push for me was to make sure the tool was only one page, was user friendly, and was easy to score. I had several experts help me, and some of the best direction I received was that I could not play around with the wording of the questions or add and subtract things from these tools or they would not be as valid. Therefore, while I did add a couple of unrelated questions into the screener, they are scored separately, leaving the screening tools in tact.
Q: What were the most helpful tools and resources that assisted you in developing the process?
I think our local behavioral health and family counselor was a great help and provided a lot of encouragement to help me get this put together. Of course, the team that put together the ECHO training session and the people who developed the actual screeners and made them available for use were also invaluable resources. It was a tedious but necessary job of sorting through available information and using what I felt applied to teens. The internet was, as always, invaluable as well.
Q: What tips would you offer other clinics that are interested in implementing a similar teen screening process?
Try to get all your providers on board and figure out a workflow. As it turns out, our MA's were not that comfortable administering this screener or talking about it, so the provider needs to make and take the time to do so.
I would also advise not to be afraid to use this tool. In our experience we learned that kids are dying to talk to someone about these issues, and unfortunately it usually isn't their teachers or parents. Their provider seems to be neutral and safe. We are currently trying to implement this in our local emergency room, and there is a little more difficulty in a hospital situation.
Q: Since implementing this teen screening process, are there any parts of the process that you feel need some fine-tuning?
We have recently added a question about tobacco use, because we felt it was relevant. (Scored separately!) The question provides a talking point for tobacco use, including chewing and smoking, and an opportunity to touch on the really awful effects of tobacco abuse. I think it will be a continual process to try and keep the screener fresh and useful. Just remember not to mess with the actual PHQ9, SBIRT or HITS!
Q: Who can clinics contact if they have further questions about the teen screening tools?
Please contact myself, Kate Barrett, at Winding Waters Clinic if you have questions. Our pediatric Nurse Practitioner, Kathy Siebe, has administered the highest number of these screens, and would be happy to discuss them with anyone interested as well. I can put people in touch with her if they have further questions.
Kate Barrett is a Care Coordinator at Winding Waters Clinic in Enterprise, OR. Email her at email@example.com
Access the Teen Screen Tools on our Resources page >>>
Watch a recording of the Institute webinar Strategies for Rural, Small Independent Practices, during which Winding Waters Clinic staff share their transformation and improvement strategies.