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Brief parental screening for depressive symptoms is designed to be incorporated into the routine well care of pediatric patients. The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department.
Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. Factor analysis of the Zung self-rating depression scale in a large sample of patients with major depressive disorder in primary care. Concurrent validation of the 21-item and 6-item Hamilton Depression Rating Scale versus the DSM-IV diagnostic criteria to assess depression in patients with Parkinson's disease: an exploratory analysis.
Rapid screening for depression—validation of the Brief Case-Find for Depression (BCD) in medical oncology and palliative care patients.
Identifying depression in primary care: a comparison of different methods in a prospective cohort study. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis.
Comparative assessment of Yale Single Question and Beck Depression Inventory Scale in screening for depression in multiple sclerosis. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. It is important to define the tasks involved in the screening and assign responsibilities to various staff members.
The following steps are designed to assist the lead clinician and other staff in setting up a screening program in their practice.A senior pediatric provider who wishes to add parental depression screening to their practice must champion the program with their colleagues and staff. Fortunately, primary care researchers have developed useful and highly practical screening tools that can be administered by physicians or self-administered by patients.
Many libraries offer online clearance items kitchen and kitchen renovated tools perform like new, but they offer less than market price and save families a lot of money to be used in other families…. We recommend forming a small group of about three people (one clinician and one to two staff) to lead the practice through the process of designing and implementing the new screening procedures. These initial screening questions all require confirmation by the physician using a detailed clinical interview or a longer, but more specific, diagnostic instrument. Every person in the practice plays a critical role in implementing the screening program, so representatives from all aspects of the operation should be included in the small leadership group.Figure 2 is a worksheet that summarizes the steps needed to prepare to implement depression screening for parents.
The question was tested prospectively in a group of 1,432 men and 1,085 women presenting to an emergency department with an injury. All rights reserved.The most widely used and best-validated instruments in the primary care setting are the PHQ-9 and its two-item version, the PHQ-2 (Table 1). Our nursing staff really got behind the screening effort—as mothers, they knew how tough the job could be."Dr.

The sensitivity and specificity using a cutoff of more than four or five drinks in the past three months were both 86 percent. In a higher-risk patient with a 30 percent pre-test probability, the posttest probabilities of depression are 81 percent with a positive screen result and 8.1 percent with a negative result. The first step is to meet with everyone in your practice and engage them in a discussion about the reasons for screening parents for depression and how it will improve patient care. The clinician champion can present the benefits of screening based on materials in this manual. Issues such as staff or clinician turnover or being in the middle of a change to an electronic medical record system can affect a practice's ability to initiate and maintain change. In patients with a positive screen result, the PHQ-9 or HAM-D instrument should be performed to confirm the diagnosis and assess severity. Practices should start parental depression screening when other aspects, such as clinical volume, staffing, and medical records systems, are relatively stable.Develop Your Practice ApproachWhen and Who to ScreenEffective screening requires a systematic method of identifying parents to screen and conducting the screening.
Since depression and depressive symptoms can occur at any time and their severity may fluctuate, screening should be ongoing. If a parent has numerous children in the practice and is seen several times over a few months, you may choose not to screen each time.Although the screening questionnaire is very brief, discussion with parents who are symptomatic or have concerns may require additional time that is best incorporated into well visits. The well-child visit is also the setting where parents expect to discuss parenting, their child's behavior, and development.
These questions have been widely tested and shown to accurately identify adults at high risk for a depressive disorder. Using the two questions in an interview format requires that the pediatric provider remember the two questions, weave them into the interview, and ask them consistently.
A copy of our recommended screening form and information on scoring the PHQ-2 is provided in the appendices. The form includes a brief introduction about why their pediatric provider is screening.The PHQ-2 is a screening tool and does not diagnose depression. Parents who report symptoms or score at risk need to complete a more comprehensive assessment or be referred for assessment and treatment with another clinician.
It asks about each of the DSM-IV diagnostic criteria, and the score provides provisional diagnoses and treatment recommendations. A copy of the PHQ-9 and directions on how to score it are found in the appendices.A popular depression screening tool for postpartum women is the Edinburgh Postnatal Depression Scale (EPDS). It detects anxiety and depressive symptoms and, if used, the provider should expect more women to screen positive. Information on scoring and the questions for the EPDS tool are found in the appendices.Explore Available ResourcesOne way to identify resources for your patients is to contact mental health and primary care clinicians in your community. After describing the proposed change in your practice, discuss your referral needs and how the referral process would work when you have a parent with an urgent need and one with a routine need. A discussion at grand rounds at your local hospital or other medical staff meetings might identify other providers in your community who are interested in addressing this critical issue.Resources for parents with depression vary widely by community.

If the parent is uninsured and does not have a primary care provider there may be services available on a sliding scale or through state-funded programs. The majority of those patients will have a primary care provider and may be referred to them for additional assessment and treatment. If you do not identify an organization that can provide additional assessment, a staff member may be trained to score the PHQ-9 and refer the patient as needed. The role of the pediatric provider in parental depression screening has been described earlier.
Below is a sample script that has been used to inform parents about depression screening during their child's visit.
If the screen is asked on a separate paper survey, an introduction can be included on the survey."Since you were last here, we have implemented a new program that includes a depression screening tool. We know that a parent's mood and emotional health significantly affect children, so we are interested in identifying and referring parents who might be depressed.
Please feel free to take any that interest you.""As part of our routine care of your child, we are asking all parents who come in with their children to complete a depression screening form. We know that depression affects both parents and their children, so we are asking for this information as a part of your child's routine care. Jones will discuss the results with you and offer some resources that can be helpful if you are interested."It is important that practice staff who distribute or collect the survey information are comfortable dealing with common patient questions. If your practice decides to offer parents further assessment or referral assistance, appropriate staff will need to receive training on the PHQ-9 and referrals procedures.Develop System to Distribute Screener and Record ResultsOnce your practice decides which parents will be screened, it is necessary to develop a system to identify those parents when they present at the practice.
Your practice probably has a system for identifying types of visits and paperwork for each type of visit.
Your decision about when you will screen the parent and which tools you will use may be determined, in part, by your current processes, such as using a paper health history or an electronic medical record (EMR). If a paper screener is used this may be charted or results of the screener may be noted in a problem list, visit notes, or other location based on other documentation of the events of a visit.Change Office Environment and Select MonitorIn addition to discussing parental depression during visits, a practice can heighten parental awareness and education about depression by placing posters and brochures in waiting rooms, hallways near scales, bathrooms, and exam rooms. A simple method for determining how to incorporate parental depression screening into your practice is a "walk through." Pretend that you are a parent coming to a well visit and examine the activities that occur at each encounter during the visit. One way to ensure consistent screening is to incorporate screening tasks into a job description, just as measuring height, weight, and blood pressure are incorporated into the job of a roomer, who prepares the child for the visit.This manual includes a set of tools to help your practice carry out the tasks required to screen for parental depression. All staff involved in the planned approach should be trained in the use of the tools and the approach.
If an EMR is used the system can be set up to prompt discussion of the PHQ-2, recording the results in the problem list, or tracking referrals.Practices found that some of the posters that were strategically placed in the rooms, lobby, or by the baby scales prepared families for the screening and discussion. Access to educational materials and Web resources in the rooms made the clinician's discussion of both parental depression and parenting issues more efficient.Figure 4.

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