P3.053: Improving Depression Screening and Appropriate Response in Child Advocacy Centers

Purpose/Objectives: The child advocacy centers (CACs) at our institution have experienced more patients presenting with depression and suicidal ideation since the COVID-19 pandemic. Literature supports the increased risk, stating suicide is the second most common death in adolescents. Patients evaluated in the CACs often have multiple ACEs and risk factors which may increase the risk of depression and suicidality. Currently, there is no national standard regarding implementation of depression screening at CACs. The objective of this project is to minimize the impact of depression in 12- to 17-year-old patients in four CACs by providing standardized PHQ-9 screening and ensuring all positive scores have appropriate intervention.

Design/Methods: The Model for Improvement and rapid cycle PDSAs (Plan-Do-Study-Act) were utilized for the project framework. At baseline, there were no standardized depression screenings provided during CAC medical evaluations. A readiness checklist was completed by CAC clinical teammates to determine preparedness to implement mental health screenings as part of a routine CAC visit. An interdisciplinary workgroup was formed to design crisis protocols for actively suicidal patients and to develop an emergency mental health resource list. A workflow was designed to complete PHQ-9 screening, screen scoring, data entry into the electronic health record (EHR), and documentation of appropriate interventions. An Epic dot phrase was embedded in the CAC note template for the PHQ-9 score and intervention documentation. The workgroup met monthly to review data and identify any workflow issues.

Results: From January 2024 to February 2025, a total of 153 patients were screened across four CACs. Performance of screen completion increased from zero to a median of 90% and sustained at or above 90% during the last 5 months of the project from October 2024 to February 2025. 88% of the 100 positive screens received interventions and were connected to resources based on their acuity. The performance of the response to positive screens improved from 33% to 100% and has sustained at 100% since August 2024. The median for positive screens was 61%, ranging from 48% to 100%.

Conclusion/Discussion: Depression screening improved to 90% and over half of the patients who completed the PHQ-9 depression screening resulted with positive scores. By implementing a standardized depression screen routinely at the four CAC locations, additional risk factors were identified outside of the patients’ ACEs. Supported by our data, the impact was apparent with 88% of positive screens receiving appropriate interventions and connection to resources based on specific scores and acuity levels. This project confirms that implementing routine depression screenings at CACs, such as the PHQ-9, could significantly reduce the risk of negative health outcomes associated with depression and minimize the risk of suicidality.