Semester

Fall

Date of Graduation

2022

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Not Listed

Committee Chair

Suzy Mascaro Walter

Committee Member

Lauren Swager

Abstract

Evaluating the Feasibility of a Collaborative Care Clinical Pathway for the Treatment of Adolescent Depression and Anxiety in Rural Pediatric Primary Care

Kayla Watson

Background: Due to a national shortage of Child and Adolescent Psychiatrists (CAP), Primary Care Providers (PCP) are often required to manage patients with mental health disorders despite a lack of focused training and lower self-efficacy or confidence in the management of these disorders. Referral to CAPs for management following the diagnosis of adolescent depression and anxiety is a common practice. The integration of mental health services within the primary care setting can overcome many of these barriers and have been shown to improve patient outcomes. This model involves PCPs prescribing psychotherapeutic drugs while the patient receives evidence-based psychotherapies provided by community Behavioral Health Clinicians (BHC).

Purpose: The purpose of this quality improvement (QI) project is to incorporate evidenced-based practice recommendations and select components from integrated care models (ICM) to design a collaborative care, decision making pathway for PCPs to utilize in the management of adolescent depression and anxiety and to evaluate the feasibility of the intervention within the primary care practice setting.

Methods: A literature review and synthesis was completed to gather current recommendations and determine the most effective components of ICMs. A collaborative clinical decision-making pathway was designed and presented to the project participants in the form of a PCP packet containing a medication guide, a treatment algorithm, a BHC provider directory, and a list of built in EMR visit and patient handout templates for clinical use. A focus group was held with project participants following a 12- week implementation period to determine the feasibility of the project. Focus group data were evaluated by coding responses and identifying common themes relating to feasibility. Future directions of the project were also discussed. Pre-implementation and post self-efficacy mean scores on a modified version of the Mental Illness Management (MIM) questionnaire were calculated as a secondary outcome measure.

Results: The clinical decision-making pathway was determined to be feasible within the intended practice setting based on the feasibility areas of emphasis: acceptability and demand. Mean scores of the MIM questionnaire showed a positive trend for each of the survey items suggesting the intended effect on care delivery.

Discussion: This QI initiative met each project aim through successful implementation and by an increase in provided collaborative care, an increase in the level of integration within the practice setting, a positive trend in PCP self-efficacy following implementation, and a decrease in the time from diagnosis- to- treatment of adolescent depression and anxiety. Following the determination of intervention feasibility, further testing within the organization is recommended and warranted.

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