PPCQN: Transformative & Evidence-based Approaches to Mental health & Substance use Screening (TEAMSS)

The AAP Pediatric Primary Care Quality Network will engage pediatricians and multi-disciplinary teams in a virtual learning network to identify, evaluate, and ensure appropriate screening for substance use and mental health concerns in adolescent patients.

About the Project

Project core components will include the use of quality improvement methods and clinician training focused on improving provider knowledge and confidence on appropriate screening and follow-up. The Academy will employ the Institute for Healthcare Improvement Model for Improvement framework, and practice sites will conduct Plan-Do-Study-Act (PDSA) rapid cycle testing to assess and implement practice and physician level changes. Additionally, this multidisciplinary approach will include recommended interventions developed by substance use and mental health experts at the AAP and will incorporate recommendations in the AAP Blueprint for Youth Suicide Prevention.

To learn more about this project and/or be notified when enrollment opens for primary care practices, please join our listserv. 

Project Leadership

Physician Leaders
Cheryl Courtlandt, MD – Quality Improvement Coach
Ulfat Shaikh, MD, MPH, MS – Project Leader

AAP Staff
Anna Correa, MPH 
Jennifer Monti, PhD 
Brittany Jennings, MHA
Jessie Leffelman
Jenna Brown

Project Time Period 

Spring 2024 - Spring 2025

Recruitment will begin in February 2024 with a promotional webinar. Click here to register for the promotional webinar. 

Project Aims & Measurement 

The goal of this project is to leverage quality improvement techniques and clinical education to improve substance use screening and appropriate follow-up, as well as improve screening for depression, anxiety, and suicide risk in adolescent patients.

• Substance use screening: % of adolescents seen for a well visits who have documentation in their chart that an accepted1 or validated2 substance use screening tool was administered and scored/interpreted
• Follow-up to positive screening for substance use: % of adolescents with a positive screening for substance use with documentation of receiving brief advice/brief intervention AND/OR referral to treatment and plan for follow up
• Depression screening: % of adolescent well visits with documentation that  an accepted1 or validated3 depression screening tool was administered and scored/interpreted.
• Follow-up to positive screening for depression: % of adolescents with a positive screening for depression with documentation of receiving brief advice/brief intervention AND/OR referral to treatment and plan for follow up
• Suicide risk screening: % of adolescent well visits with documentation that an accepted1 or validated4 suicide risk screening tool was administered and scored/interpreted.
• Follow-up to positive screening for suicide risk: % of adolescents with a positive screening for suicide risk with documentation of receiving brief advice/brief intervention AND/OR referral to treatment and plan for follow up
• Anxiety screening: % of adolescent well visits with documentation that an accepted1 or validated5 anxiety screening tool was administered and scored/interpreted.
• Follow-up to positive screening for anxiety: % of adolescents with a positive screening for anxiety with documentation of receiving brief advice/brief intervention AND/OR referral to treatment and plan for follow up

Notes

Accepted screening tool:

• A screening tool not in the “Validated” list below, but that has been reviewed by the project leader and QI coach and determined to be suitable to the clinic’s patient population and context.
• Rationale: Bright Futures recommends universal screening for behavioral/social/emotional concerns, adolescent depression and suicide risk, and substance use at selected visits. Several validated tools are available for screening and the list below is not exhaustive. While we strongly recommend selecting a validated screening tool, we can provide guidance to participating clinics as they identify an acceptable screening approach that works best for their patient population and context.

Validated substance use screening tools:

• BSTAD (Brief Screener for Tobacco, Alcohol, and other Drugs)
• CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble)
• S2BI (Screening to Brief Intervention)

Validated depression screening tools:

• PHQ-2 (Patient Health Questionnaire-2)
• PHQ-A (Patient Health Questionnaire-Adolescent)
• PHQ-9 (Patient Health Questionnaire-9)
• CES-DC (Center for Epidemiologic Studies Depression Scale for Children)
• CDI (Children’s Depression Inventory)
• Beck Depression Inventory-II
• PSC (Pediatric Symptom Checklist)

Validated suicide risk screening tools:

• C-SSRS (Columbia Suicide Severity Rating Scale)
• ASQ (Ask Suicide-Screening Questions)
• Suicide Behaviors Questionnaire (SBQ)

Validated anxiety screening tools:

• GAD-7 (Generalized Anxiety Disorder-7)
• GAD-2 (Generalized Anxiety Disorder-2)
• SCARED (Screen for Child Anxiety Related Disorders)

Project Results 

Please check back in Spring 2025 for a comprehensive list of project resources, results, and possible publications.