Implementation of caregiver depression screening in an urban, community-based asthma clinic: a quality improvement project

Authors

Rachel H. Margolis, Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA.
Shilpa J. Patel, Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA.
Taylor Brewer, Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA.
Casey Lawless, Children's Mercy Kansas City Hospital, Kansas City, MO, USA.
Julie Krueger, Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA.
Eduardo Fox, Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA.
Nikita Kachroo, Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA.
Shayla Stringfield, Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA.
Stephen J. Teach, Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA.

Document Type

Journal Article

Publication Date

3-7-2023

Journal

The Journal of asthma : official journal of the Association for the Care of Asthma

DOI

10.1080/02770903.2023.2178935

Keywords

Depression; parent; psychosocial

Abstract

OBJECTIVE: Caregiver depressive symptoms are prevalent among children with asthma and associated with greater asthma morbidity. Identifying caregivers with depression and connecting them to appropriate treatment may reduce child asthma morbidity. The goal of this project was to implement a workflow for caregiver depression screening and treatment referral in an urban, community-based, asthma clinic serving under-resourced children. METHODS: The Model for Improvement with weekly Plan-Do-Study-Act cycles was utilized. A two-item depression screening tool (Patient Health Questionnaire-2; PHQ-2) and an acceptability question using a 5-point Likert scale were added to an existing social needs screening checklist administered to all caregivers during the child's clinic visit. Caregivers with a positive PHQ-2 score (≥3) received the PHQ-9. Positive screens on the PHQ-9 (≥5) received information and referrals by level of risk. PHQ-9 positive caregivers received a follow-up phone call two weeks post-visit to assess connection to support, improvement in depressive symptoms, and satisfaction with resources provided. RESULTS: The PHQ-2 was completed by 84.4% of caregivers (233/276). Caregivers had a mean age of 33.8 years (SD = 8.3; Range: 18-68) and were predominately female (86.4%), Black (80.4%), and non-Hispanic (78.4%). The majority (72.3%) found the screening acceptable (agree/strongly agree). Nearly one in six caregivers (37/233, 15.9%) reported depressive symptoms (PHQ-2 ≥ 3); 11.6% (27/233) had clinically significant symptoms (PHQ-9 score ≥ 10); and 2.1% (5/233) reported suicidal thoughts. Of those with depressive symptoms, 70.3% (26/37) participated in the follow-up phone call. While 50% (13/26) reported the resources given in clinic were "extremely helpful," no caregivers contacted or used them. CONCLUSIONS: Caregiver depression screening was successfully integrated into a pediatric asthma clinic serving under-resourced children. While caregivers found screening to be acceptable, it did not facilitate short-term connection to treatment among those with depressive symptoms.

APA Citation

Margolis, Rachel H.; Patel, Shilpa J.; Brewer, Taylor; Lawless, Casey; Krueger, Julie; Fox, Eduardo; Kachroo, Nikita; Stringfield, Shayla; and Teach, Stephen J., "Implementation of caregiver depression screening in an urban, community-based asthma clinic: a quality improvement project" (2023). GW Authored Works. Paper 2607.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2607

Department

Pediatrics