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Urban clinic successfully uses Internet for mental health screening
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BOSTON — Web-based screening tools can successfully be used in urban pediatric practices, according to study results presented here at the 2012 Pediatric Academic Societies Annual Meeting.
Researchers from Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, N.Y., investigated the barriers to using a Web-based mental health screening tool for school-age children in an inner-city pediatric practice and found that screening tools are viable options for primary care practices in urban settings as long as there is a facilitator to help patients.
“We found that parents are very satisfied with this screening process,” Diane E. Bloomfield, MD, assistant clinical professor in the department of pediatrics at Albert Einstein College of Medicine, told Infectious Diseases in Children. “In fact, 69% of them said it helped their doctor identify their concerns and 67% said it improved their communication with their physician during the visit. It streamlined the visit and it led to greater satisfaction with the entire visit.”
The cross-sectional study included 175 English and Spanish speaking caretakers. Most of the participants were women (80%) and had at least a high school degree (53.7%). Forty-nine percent were Hispanic, 30.7% black and 14.1% identified themselves as black/Hispanic. A bilingual facilitator guided the parents through the process of registering for the Internet platform CHADIS, where they completed the validated mental health screen, the 17 item Pediatric Symptom Checklist.
Results showed that 83.5% of participants found CHADIS (Child Health and Development Interactive System) easy to use, and 68.6% felt the Web-based tool helped their doctor to better identify their concerns; 67.2% of participants felt the use of CHADIS improved their communication with the physician.
“We think it’s a wonderful way to learn more about your patients’ mental health in a non-invasive way and with a tool that they feel comfortable using,” Bloomfield said.
Those who indicated on the survey that they would not use the screening tool in the future (13.3%) were “significantly more likely to report discomfort sharing personal information online (OR=2.0; 95% CI, 1.05-3.82),” according to study findings.
This portion of the study respondents also reported concerns about their ability to use a computer properly (OR=2.7; 95% CI, 0.95-7.59). Results also showed that without a high school education, participants (15%) were significantly more likely to have concerns about finding a facilitator to help them complete the survey (OR=4.5; 95% CI, 1.53-12.9).
Bloomfield also said that for children aged older than 11 years, a youth form is available for the patient to complete in addition to the parent form.
“We found that adolescents were more willing to fill out a questionnaire and describe their problems than they are when directly confronted by the pediatrician,” she said. “We have found that the parent and adolescent forms are sometimes quite different because the silent, suffering adolescent has often not felt comfortable enough to share this information. It leads to a much fuller visit.”
Lynn Davidson, MD, who is assistant professor in the department of pediatrics at Albert Einstein College of Medicine, and is one of the study investigators, said that all pediatricians should be screening their children for mental health issues, and each practice should pick a modality that works for them.
“This questionnaire allowed us to identify children who may not have been identified otherwise,” she said. “You can pick up early mental health issues before they become a crisis. This is a good way to prevent those crises and sometimes initiate a short-term intervention rather than dealing with a more expensive and long-term intervention.”
For more information:
- Bloomfield D. #1506.153. Presented at: the 2012 PAS Meeting; April 28–May 1, 2012; Boston.
Disclosure: Dr. Bloomfield reports no relevant financial disclosures.
Perspective
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Robert J. Hilt, MD, FAAP
The use of rating scales to both screen for and track the outcomes of child mental health care within primary care practices is a widely encouraged practice. However, there are numerous barriers to this routine use of rating scales, including questions about their individual validity and utility; difficulty incorporating their use into the practice’s workflow; and provider concerns related to the appropriate response to any positive screening results.
The report by Bloomfield and colleagues evaluated parent acceptability of one way to facilitate the incorporation of rating scale use into the clinic workflow — which involved asking parents to complete a rating scale online (with results available to the practitioners’ online) rather than on paper. CHADIS is an internet-based platform for parents to complete mental health rating scales, which is available for a non-trivial annual subscription fee to medical practitioners. This study looked at the use of this system to administer the PSC-17, a free and validated general mental health screening rating scale. Most urban parents using the system reported it was easy to use, and only a minority had concerns about sharing sensitive information online or about the use of a computer.
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