PROBLEM STATEMENT: An estimated 3.1 million adolescents in the United States experience depression episode each year. Adolescents experiencing depression are prone to poor academic performance, impaired social functioning, increased incidence of substance abuse, and increased risk for suicide. Primary care providers often do not conduct depression screenings during healthcare visits for various reasons. Southwest Virginia school system does not have a depression screening protocol making depression symptoms often unidentified. SUMMARY OF EVIDENCE: Depression screenings should be conducted during well child exams. Missed screenings place adolescents at risk for poor healthcare outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: The pediatric nurse practitioner health services coordinator for southwest Virginia schools conducts well-child exams for adolescents. Depression screening was an area for practice improvement. VALIDATION OF EVIDENCE: The Patient Health Questionnaire (PHQ)-2 was administered during the health service coordinators’ well child visit and aggregate data was collected on a handwritten form relaying the PHQ-2 score, PHQ 9 score, and referral to parent. RELEVANCE OF PMH NURSING: All students receiving a well child visit over 8 weeks were screened for depression (n=44). There were 16 (35.5%) of students who screened positive on the PHQ-2 and were administered the PHQ-9. There were 13 (81.3%) (n=16) students who were administered the PHQ-9 and scored greater than 4. The number of referrals to parents generated were 10 (76.9%) (n=13). FUTURE IMPLICATIONS: Southwest Virginia schools need a policy and procedure describing the administration of the PHQ-2 and PHQ-9 screening instrument.

People living with HIV/AIDS (PLWHA) are 4 times more likely to have a diagnosis of depression than persons without HIV. The specific problem at a rural clinic in a southern region of the United States, was a lack of continuity in the Patient Health Questionnaire 9 (PHQ-9) screening procedures that made sure that PLWHA were screened, identified, and referred. Early identification and treatment can help patients cope with barriers that affect health outcomes. The purpose and goal of this project was to develop and implement an evidence-based depression screening protocol to improve clinical staff practices and adherence to the PHQ-9 guidelines thereby increasing the number of PLWHA who were diagnosed and treated for depression. The Iowa model of evidenced-based practice served as a guide for this project. An interdisciplinary team was assembled to develop protocols and staff training. This project compared clinic staff knowledge on depression through pre and posttests. Upon completion of staff training, the pretest had a M = 78.33 and SD = 11.146 and the posttest a M = 99.17 and a SD = 2.887. Results of a paired t test confirmed a statistically significant increase in knowledge with p < .000. Over a 4-week period, depression screenings at the study site went from 10% to 100%. Data showed that positive social change was realized when PLWHA began to get depression treatment because of proper screening, early interventions, and depression management. Although the project is designed for the PLWHA in the rural clinic, other primary care providers may find that an evidenced-based practice protocol can be useful to improve PHQ-9 depression-screening practices for patients in other clinical areas.

Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.