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

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