Feasibility and Impact of an Internet-based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency Department

Authors

Joel A. Fein, M.D. M.P.H, The Children's Hospital of Philadelphia
Megan E. Pailler, Ph.D, The Children's Hospital of Philadelphia
Frances K. Barg, Ph.D. M.Ed., University of Pennsylvania School of Medicine
Matthew B. Wintersteen, Ph.D, Thomas Jefferson UniversityFollow
Katie Hayes, B.S, The Children's Hospital of Philadelphia
Allen Y. Tien, M.D., M.H.S, Johns Hopkins School of Medicine
Guy S. Diamond, Ph.D, University of Pennsylvania School of MedicineFollow

Document Type

Article

Publication Date

12-2010

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Archives of Pediatrics and Adolescent Medicine Volume 164, Issue 12, December 2010, Pages 1112-1117. The published version is available at DOI: 10.1001/archpediatrics.2010.213. Copyright © American Medical Association

Abstract

Objective: Determine the adoption rate of the web-based Behavioral Health Screening- Emergency Department (BHS-ED) system into routine clinical practice in a pediatric emergency department (ED), and assess its impact on identification and assessment of psychiatric problems.

Design: Descriptive design to evaluate feasibility of a clinical innovation.

Setting: ED of an urban tertiary care children’s hospital.

Participants: Non-acute, non-critical 14-18 year olds presenting with non-psychiatric complaints.

Intervention: ED clinical staff initiated the BHS-ED which assesses depression, suicide, post-traumatic stress, substance use, and violence exposure. Treating clinicians reviewed results and followed routine care practices thereafter.

Outcome Measures: Adoption rate of the BHS-ED by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before and 9 months during implementation.

Results: Of 3979 eligible patients, 1327 (33%) were approached by clinical staff to complete the BHS-ED; of these, 857 (64.6%) completed the BHS-ED, and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems significantly increased (4.2% vs. 2.5%, OR=1.70, 95% CI 1.38, 2.10) as did ED assessments by a social worker or psychiatrist (2.5% vs. 1.7%, OR 1.47, 95% CI 1.13, 1.90). Of the 857 subjects who completed the BHS-ED, 10.5% were identified (OR=4.58, 95% CI 3.53, 5.94) and 8.3% were assessed (OR 5.12, 95% CI 3.80, 6.88).

Conclusions: In a busy pediatric ED, computerized, self-administered adolescent behavioral health screening can be incorporated into routine clinical practice and can lead to small but significant increases in the identification of unrecognized psychiatric problems.

Recommended Citation

Fein, M.D. M.P.H, Joel A.; Pailler, Ph.D, Megan E.; Barg, Ph.D. M.Ed., Frances K.; Wintersteen, Ph.D, Matthew B.; Hayes, B.S, Katie; Tien, M.D., M.H.S, Allen Y.; and Diamond, Ph.D, Guy S., "Feasibility and Impact of an Internet-based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency Department" (2010). Department of Psychiatry and Human Behavior Faculty Papers. Paper 10.
https://jdc.jefferson.edu/phbfp/10