We developed and implemented a depression screening and interventions (S&I) protocol in our pediatric neurology residents’ continuity clinic. 

The prevalence of depression in children with neurological disorders ranges from 10-30%. Co-morbid depression is an important factor in the care and quality of life of these patients.  Early recognition of depression can lead to early engagement of mental health services and improvement of depressive symptoms. However, ubiquitous depression screening in pediatric neurology clinics remains a challenge.

A multidisciplinary team (resident leaders, program director, clinic manager, nurses, medical assistants, and social workers) developed the depression S&I protocol. Patient Health Questionnaire-9 Adolescent (PHQ-9A) was administered to patients age 12 to 18 years, who were developmentally capable and agreed to complete the screening. Patients received individualized interventions based on our algorithm. Serial Plan-Do-Study-Act (PDSA) cycles were performed, over nine months, to improve efficacy and workflow. PDSA cycle 1 included protocol initiation and education of residents and clinic staff. PDSA cycle 2 included further promotion and addition of dotphrases in the electronic medical record (EMR) documentation. PDSA cycle 3 consisted of re-education and provision of reminder cards at workstations. Measures included percent of eligible patients screened and percent of screened patients who received appropriate interventions.

During PDSA cycle 1, 57% of eligible patients were screened, of which 79% received appropriate interventions. After PDSA cycle 2, screening and appropriate intervention rates remained stable at 58% and 81%, respectively. Following PDSA cycle 3, the screening rate increased by 13% while the appropriate intervention rate was relatively maintained (78%). During the study, 19% of patients had moderate and severe scores, and one patient endorsed active suicidal ideation.

After implementation of the depression S&I protocol, patient screening rates increased through education and EMR-based changes. Future research will include assessment of trends in patients' scores and symptoms after protocol implementation.