Teen Mental Health Project
Professor of Pediatrics and Community & Family Medicine, Geisel School of Medicine at Dartmouth
Behavioral health- depression
Concord Pediatrics, Gifford Medical Center Pediatrics, CORE Pediatrics-Epping, CORE Pediatrics-Exeter, CORE Pediatrics-Plaistow, Dartmouth-Hitchcock-Concord Pediatrics, Dartmouth-Hitchcock Medical Center-Family Medicine, Little Rivers Health Care-Bradford, Middlebury Pediatrics, Newbury Health Center, Robert A. Mesropian
The goal of this project is to assist pediatric and family medicine practices to implement a systematic approach to identify teens at high risk for depression by routine screening at health check ups. Practices are trained to evaluate, manage, and monitor progress of teens that screen positive for depression. Key steps of the project will: •Provide clinicians and nurses with training to enhance office care and optimize mental health referrals. •Support systemic follow up by the practice with a confidential web-based teen registry to fulfill three key functions: 1.Provide prompts and reports to insure regular follow-up and patient assessment; 2.Assistance by Adolescent Psychiatrist who can provide consultation via a listserv and by reviewing the progress of patients in the registry; and 3.Tracking by practice staff of objective measures (depressive symptoms, medication and referral compliance). Practices interested in participating will be asked to: •Designate a practice “Project Contact Staff member” and a clinician “Practice Leader” who will work with Dartmouth staff over 9 months to establish a system of depression screening, and consistent follow up utilizing the registry. •Have clinicians participate in an on-site training and web-based seminars, conducted by the Dartmouth Adolescent Psychiatrist to enhance evaluation and management skills for teen depression. Ongoing consultation about depression management is available from Adolescent Psychiatry via a listserv for the clinicians in the project. •Routinely use a validated depression screener (PHQ-9 Adolescent) during teen well-child visits using either a paper-based or electronic screener (HealthyTeens PDA). •Have a designated nurse(s) who will contact families in follow up calls and maintain the registry of teens that screen positive. •Complete baseline and follow-up interviews or surveys assessing current “best practices”, and attitudes about screening, evaluating and managing teen depression. The project will be recruiting practices in 3 cycles over the three years of the grant. The first practices participating are from the Randolph Vermont region and Concord NH. Additional practices from other communities will be able to participate and receive training in the fall of 2011 and spring 2012.
Over 6,000 teens have now been screened for depression since the inception of this project two years ago. Over 600 teens have been entered into the registry for ongoing monitoring and treatment. Early findings are that: •Many more girls than boys – nearly four to one – have screened positive and are being monitored through the registry; •Over three-quarters of teens/families are receiving follow-up monitoring/care by the PCP; •Over 80% have received referral for further mental health support and services; and •Of the 10% of teens who screen positive for depression risk, 24% have had serious thoughts in the last month of ending their life. Early conclusions: •Practice support and training has resulted in screening with the adolescent version of the PHQ-9 as a standard of care. Monitoring is being documented and nearly half of the adolescents have had a primary care follow-up visit within 8 weeks from screening. •The adolescent PHQ-9 has three questions assessing suicidal intent. One in six adolescents who screen positive, do so on the basis on the suicidality alone. These would not be detected using the adult version of the PHQ-9. •Primary care practices can be prepared to assess, manage and monitor teens for depression and suicidality and fill a critical gap and improve outcomes for teens at risk for depression and suicide.