Abstract
BackgroundScreening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments.ObjectiveThis qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW.MethodsWe interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups.ResultsWe identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions.ConclusionsWe identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW.
Highlights
Adolescent suicide rates have increased by 20% in the past decade and are the second leading cause of death for ages 10 to 24 years in the United States [1,2].Screening for Depression and SuicidalityAs depression and suicidal ideation are strong risk factors for adolescent suicidal behavior [3], screening for depression and suicidality have become national priorities, with depression screening being a billable International Classification of Diseases, Tenth Revision, diagnosis code and a covered preventive service often used as a quality measure in pediatric quality initiatives [4]
We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric primary care providers (PCPs) agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; Screening Wizard (SW) is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions
SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and https://mental.jmir.org/2021/9/e26035
Summary
Adolescent suicide rates have increased by 20% in the past decade and are the second leading cause of death for ages 10 to 24 years in the United States [1,2].Screening for Depression and SuicidalityAs depression and suicidal ideation are strong risk factors for adolescent suicidal behavior [3], screening for depression and suicidality have become national priorities, with depression screening being a billable International Classification of Diseases, Tenth Revision, diagnosis code and a covered preventive service often used as a quality measure in pediatric quality initiatives [4]. The United States Preventive Services Task Force recommendations highlight that screening programs alone are unlikely to improve care for depression or have a measurable impact on reducing suicide rates among adolescents. The reasons include primary care providers’ (PCPs) unfamiliarity and variability in the interpretation of screening results [7], failure to assess and address patients’ and parents’ barriers to treatment [8], failure to factor in patients’ and parents’ preferences [9,10], and low motivation for treatment among patients who screen positive for depression. The revised Guidelines for Adolescent Depression in Primary Care (GLAD-PC) recommends that PCPs assess and integrate information about patient beliefs, preferences, and barriers to guide their management decisions; further research is needed to implement these guidelines [11]. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments
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