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

University of California San Diego

Status: Active, not recruiting

Conditions: Children; Depression

Treatments: Behavioral: Team-Enhanced Condition; Behavioral: Standard Condition

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06527196

810627

P50MH126231 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

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.

Full description

Aim 1: Use mixed methods to refine a team-based implementation strategy to improve implementation of an existing health system universal depression screening protocol (clinical intervention)

Aim 2: Use a two-arm hybrid type 3 implementation-effectiveness pilot trial to assess the initial effectiveness of the team-based implementation strategy on the depression screening protocol.

Aim 3: Use mixed methods to assess team/organizational (intra-organizational alignment, implementation climate) and team member/provider (communication, coordination, psychological safety, shared cognitions) mechanisms of the team-based implementation strategy and a novel application of natural language processing methods.

Enrollment: 40 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Inclusion criteria for all groups of participants are intentionally broad to ensure valid analyses:

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

Exclusion criteria

Any individual that does not meet the inclusion criteria will be excluded from study participation.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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40 participants in 2 patient groups

Standard Condition

Active Comparator group

Description:

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

Treatment:

Behavioral: Standard Condition

Team-Enhanced Condition

Experimental group

Description:

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.

Treatment:

Behavioral: Team-Enhanced Condition