Implementing Improved Mental Health Screenings in Home Health Care

Background: Depression and anxiety are among the most diagnosed mental health disorders. Moreover, those with chronic medical conditions are more likely to develop mental illness and suicidal behaviors, which validated screening tools can detect. A high correlation between mental illness and chronic medical conditions necessitates screening of home health patients. Current home health agencies in Utah and across the United States must use a federal intake form upon admission in the Outcome and Assessment Information Set (OASIS), which includes the Patient Health Questionaire-2 (PHQ-2), as Medicare recommends. Preventative screening tools like the PHQ-2 have significantly improved the staff's ability to identify mental illness and intervene appropriately. Early detection of depression is crucial for a favorable prognosis, as the research suggests that 60% to 80% of patients have positive responses when provided with adequate mental health care (Sheeran et al., 2010). Mental health carries a heavy stigma, and screening is often disregarded in medical care leading to unidentified mental illness and increased rates of suicide. In addition, although the PHQ-2 has helped identify depression, there is no current use of additional screenings for anxiety or suicidality. Local Problem: Utah's suicide rate is near twice the national average and ranks ninth in the country for suicide completion as of 2020 (Utah Department of Utah, 2023). Early identification and treatment of depression, anxiety, and suicidal ideation can significantly improve mental health and decrease suicidal behavior. Methods: This project aimed to initiate the Generalized Anxiety Disorder-7 (GAD-7) and Columbia- Suicide Severity Rating Scale (C-SSRS) screenings amongst adult home health patients. This quality improvement project (QIP) occurred in a small private practice home health and hospice agency in northern Utah. Providers and ancillary staff, which included registered nurses, licensed practical nurses, clinical nurse aids, physical therapists, physical therapist aids, and a chaplain, received educational materials. These materials included suicide prevalence information, the comorbid relationship between mental illness and other medical diagnoses, screening protocols, and resources explaining patient coping mechanisms. Measurement included pre- and post-education questionnaire results and comparing pre- and post-project mental health screening counts. Results: The clinic did not utilize valid anxiety and suicide screening tools before the quality improvement intervention. Post-intervention, providers estimated that most patients received appropriate mental health screening. The pre-intervention comfort level of provider screening for anxiety and suicidal thoughts varied from uncomfortable to comfortable. In contrast, all providers increased comfortability using the mental health screening tools post-intervention. Conclusions: The Draper, Utah, Home Health and Hospice Agency successfully initiated a standardized, validated, practice-specific anxiety and suicide screening process. Providing anxiety and suicide education and validated screening tools to providers and staff was associated with increased provider comfort levels around mental health screening and treatment. Standardized mental health screening and treatment could improve outcomes and enhance the quality of life for adult home health patients suffering from depression, anxiety, and suicidal thoughts