TEAMS R34 #3: Team-Based Implementation Strategy for Pediatric Depression Screening

NCT06527196 | Active Not Recruiting DMC

• 2 other identifiers: 810627P50MH126231
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Pediatric depression is a global concern that has fueled efforts for enhanced detection and treatment engagement. While many health systems have implemented components of depression screening protocols, there is limited evidence of effective follow-up for pediatric depression. Key barriers to prompt service linkage include a shared understanding of individual and team member roles and coordination between clinicians and staff across service areas. This project aims to refine and test a team-based implementation strategy, a team charter, improve implementation of an existing pediatric depression screening protocol in a large pediatric healthcare system. The implementation strategy will target team mechanisms at the organizational-level and provider-level. The team charter is hypothesized to lead to improved, efficient, and effective decision-making to increase the frequency of depression screening and timely service linkage. Findings are expected to yield better understanding of how to optimize team activities and patterns in the pediatric depression screening to treatment cascade. This should also culminate in improved patient engagement and outcomes, which are critical to address the youth mental health crisis.

Conditions

Depression; Children

Keywords

Depression Screening; Team Charter; Team Effectiveness

Outcome Measures

Primary Outcomes (6)

• Acceptability, Feasibility, and Appropriateness of Intervention Measure

  This 9-item instrument will be administered to participants following completion of the study intervention. The measure was designed to assess the degree to which the intervention is well-received (acceptability), relevant in the given setting (appropriate), and possible and workable (feasibility). The items on the measure (9 total) are each rated on a scale from 1 (completely disagree) to 5 (completely agree). Following completion, individual subscales (3 total) can be obtained by averaging participants' responses for each of the three components (acceptability, appropriateness, and feasibility).

  6 months

• Referral Processing Time

  Referral processing, will be based on the time (in hours) from screening to referral based on electronic health record (EHR) timestamps. This will be used to help assess workflow efficiency.

  6 months

• Provider Response Based on Patient Health Questionnaire (PHQ-9) Score

  This measure will be obtained by using the electronic health record (EHR) to determine whether or not providers responded to a patient with an elevated score (10+) on the Patient Health Questionnaire (PHQ-9). This will help researchers assess clinical outcomes of the study intervention (team communication training). Context: The Patient Health Questionnaire asks respondents to answer 9 questions that assess mental health status over the patient's last two weeks. Patients answer each question on a scale ranging from 0 (not at all) up to 3 (nearly every day). Scores are calculated by adding individual values together to produce a cumulative score (can range from 0 to 27). A higher score indicates a higher risk for depression symptomology. For the pediatric health system in this study, a score above 10 warrants referral to a behavioral health professional, as well as educational materials and other service referrals.

  Baseline, 3 months, 6 months

• Mental Health Service Linkage (Caregiver Report of Successful Mental Health Service Linkage)

  Successful mental health service linkage will be assessed by obtaining caregivers' reports of linkage to any mental health service (internal and external of study's chosen pediatric healthy system) following an elevated depression score on the PHQ-9 (10+). Context: The Patient Health Questionnaire asks respondents to answer 9 questions that assess mental health status over the patient's last two weeks. Patients answer each question on a scale ranging from 0 (not at all) up to 3 (nearly every day). Scores are calculated by adding individual values together to produce a cumulative score (can range from 0 to 27). A higher score indicates a higher risk for depression symptomology. For the pediatric health system in this study, a score above 10 warrants referral to a behavioral health professional, as well as educational materials and other service referrals.

  3 months, 6 months

• Referral Quality (Provider Report of Successful Mental Health Service Referrals)

  Referral quality is a measure based on providers' reports of whether referral to the a behavioral health service occurred or not. This will be used to assess workflow efficiency.

  6 months

• Time to Mental Health Service Linkage

  This measure captures time (days) to service linkage for patients that need referrals based on the Patient Health Questionnaire (PHQ-9) score. This data will be obtained from the electronic health record (EHR). This will help researchers assess clinical outcomes of the study intervention (team communication training). Context: The Patient Health Questionnaire asks respondents to answer 9 questions that assess mental health status over the patient's last two weeks. Patients answer each question on a scale ranging from 0 (not at all) up to 3 (nearly every day). Scores are calculated by adding individual values together to produce a cumulative score (can range from 0 to 27). A higher score indicates a higher risk for depression symptomology. For the pediatric health system in this study, a score above 10 warrants referral to a behavioral health professional, as well as educational materials and other service referrals.

  Baseline, 3 months, 6 months

Secondary Outcomes (5)

• Implementation Climate Measure

  Baseline, 3 months, 6 months

• Collaboration and Satisfaction About Care Decisions (CSACD)

  Baseline, 3 months, 6 months

• Card Sorting Activity

  Baseline, 3 months, 6 months

• Edmonson's Psychological Safety (Interpersonal Risk Taking) Climate Measure

  Baseline, 3 months, 6 months

• Family Demographics Questionnaire

  Baseline, 3 months, 6 months

Study Arms (2)

Standard Condition

ACTIVE COMPARATOR

In the comparison condition, staff will continue to use multiple discrete strategies already implemented as apart of the depression screening pathway. These existing strategies include: 1. Training in the depression screening tool (Patient Health Questionnaire) 2. Orientation to the clinical pathway (i.e., screening conducted at every urgent care or emergency department visit and every 30 days for all other medical visits) 3. Expectations for handoff to the next step in the care cascade

Behavioral: Standard Condition

Team-Enhanced Condition

EXPERIMENTAL

The team-enhanced condition will include: 1. Two initial 1-hour didactic sessions to develop the team charter. 2. Biweekly check-ins (15-30 minutes) where the research team will review ongoing use of the team charter with participants and explore any necessary revisions.

Behavioral: Team-Enhanced Condition

Interventions

Team-Enhanced Condition BEHAVIORAL

Participants in the experimental arm (team-enhanced condition) will be asked to participate in the creation and use of a team charter. This will occur over a period of six months.

Team-Enhanced Condition

Standard Condition BEHAVIORAL

Providers in the standard condition will be asked to continue practices and response to depression screening as currently implemented by the hospital system.

Standard Condition

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Employed as medical staff and/or a medical or health provider at Rady Children's Hospital San Diego.
• Experience providing or supporting care to children and adolescents with mental health care needs.

Sponsors & Collaborators

• University of California, San Diego: lead
• National Institute of Mental Health (NIMH): collaborator

Study Sites (1)

UC San Diego: IN STEP Children's Mental Health Research Center

San Diego, California, 92123, United States

Location

Related Publications (1)

• Stadnick NA, Aarons GA, Edwards HN, Bryl AW, Kuelbs CL, Helm JL, Brookman-Frazee L. Cluster randomized trial of a team communication training implementation strategy for depression screening in a pediatric healthcare system: a study protocol. Implement Sci Commun. 2024 Oct 18;5(1):117. doi: 10.1186/s43058-024-00641-5.

  PMID: 39425229 DERIVED

MeSH Terms

Conditions

Depression

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior

Study Officials

• Nicole A Stadnick, PhD, MPH

  UCSD Associate Professor

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: July 19, 2024
• First Posted: July 30, 2024
• Study Start: June 1, 2024
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): January 31, 2027
• Last Updated: November 5, 2025

Record last verified: 2025-11

Locations

US (1)