PC1232: Evaluating the Implementation of Universal Mental Health Screening in the Pediatric Hematology and Oncology Setting

Purpose/Objectives: Data has shown that children with hematological and oncological diagnoses often have significantly higher rates of mental illness compared to their healthy peers. Universal mental health screening is recommended during pediatric well child visits. However, there are no recommendations for screening during subspecialty visits. In our institution, a mental health screening process in the Pediatric Hematology and Oncology (PHO) clinic was implemented. We report on this process and screening results.

Design/Methods: A Plan, Do, Study, Act (PDSA) quality improvement model was utilized. Patients greater than 12 years old were screened with PHQ-2 and GAD-2. If a patient’s score was > 3 on the PHQ-2 or GAD-2, they were required to complete the PHQ-9 or GAD-7, respectively. To study this process, a retrospective chart review was conducted to analyze screening over the first seven weeks of initiation. All patients over age 12 seen in the PHO clinic were included. Data was collected regarding screening scores, diagnosis type, suicidality, and social work intervention with the goal of identifying gaps in the screening process for the next PDSA cycle.

Results: 334 patient encounters occurred during this 7-week period. Of these, 50 patients were not screened, resulting in a 15% miss rate (Table 1.) Bone marrow transplant appointments had a high miss rate (33.3%.) Among those screened, 8.6% and 8.9% had PHQ-2 and GAD-2 scores that were high enough to require completion of the PHQ-9 and GAD-7, respectively. By diagnosis category, patients with bleeding disorders had the highest rate of requiring PHQ-9 completion at 31% (Table 2.) During 10 encounters, patients expressed suicidal thoughts. Among the 334 patient encounters, 46.4% met with a social worker. In particular, 82.7% and 76.6% of patients requiring completion of the PHQ-9 and GAD-7, respectively, were seen by social workers.

Conclusion/Discussion: The results of this analysis suggest that universal mental health screening is feasible in a subspecialty setting. To address the remaining gap, the next quality improvement cycle will consider specific subgroups within the PHO department, such as bone marrow transplant encounters, to understand their workflow and improve screening rates. Additionally, results show that patients with bleeding disorders have high rates of PHQ-9 and GAD-7 completion, indicating potentially higher rates of anxiety and depression. This demonstrates a need for further follow up and evaluation of these patients. Finally, approximately 20% of patients with high PHQ and GAD scores did not meet with a social worker during their visit. Next steps are to understand the staffing requirements needed to offer social work assistance in a consistent manner. In summary, universal mental health screening is important to perform in the PHO setting and further PDSA cycles are needed to improve the process and increase resources for this patient population.