706 - A Framework to Execute Pediatric Anxiety Screening Guidelines in Primary Care

Publication Number: 706.3817

Shengyi Mao, Ohio State University College of Medicine, Columbus, OH, United States; Hannah Parks, Ohio State University College of Nursing, Columbus, OH, United States; Susan Friedman, Ohio State University Medical Center, Worthington, OH, United States; Rachel Gordon, Ohio State University College of Medicine, Columbus, OH, United States; Nazhat Taj-Schaal, Ohio State University College of Medicine, Lewis Center, OH, United States

Background: Recent stressors including the COVID-19 pandemic raised the prevalence of anxiety disorders. The 2020 National Survey of Children’s Health found that 9.2% of children ages 3-17 had an active anxiety disorder. Primary care is an ideal setting to screen for anxiety and early recognition can facilitate evidence-based treatments. In October 2022, the United States Preventative Services Task Force (USPSTF) recommended screening all children ages 8-18 (grade B recommendation) for anxiety.

Objective: Our academic hospital associated primary care clinics aimed to systematically screen patients 8-11 years of age at preventive visits for anxiety.

Design/Methods: We routinely screen patients ages 12-18 for anxiety and depression using the Patient Health Questionnaire-4. This project focuses on implementing routine anxiety screening for patients ages 8-11 using quality improvement (QI) processes. We administered a 5-question validated anxiety screening tool—the Screen for Child Anxiety Related Disorders (SCARED) Brief assessment—at well visits for patients ages 8-11. The full 41-item SCARED questionnaires were administered if the brief screen was positive. Three providers piloted this process for one month before expanding to all providers across four Internal Medicine and Pediatrics clinics. We collaborated with information technology to create fields in our electronic health record (EHR) to input results and created dashboards to track our progress.

Results: From September 2023 to September 2024, 854 patients ages 8-11 years completed a SCARED Brief at 1,081 well visits. Initially, anxiety screening rates at well visits ranged from 10-65% by clinic, increased to 75% after one month, and sustained an average of 82% from December 2023 to September 2024. Of the completed screenings, 303 patients (32.8%) screened positive. Of 92 full SCARED assessments, 50 (54.3%) were positive, suggesting an anxiety disorder.

Conclusion(s): Universal anxiety screening using the SCARED Brief assessment at well visits for patients ages 8-11 is an effective way to implement USPSTF recommendations. Brief screening identified a third of patients needing further assessment for anxiety, and half of those completing follow-up assessments indicated an anxiety disorder. Initial barriers to screening included an inability to discretely document results. Adding documentation fields in our EHR enabled us to easily document, track, and analyze data. Time constraints and inconsistent follow-up hindered our ability to consistently administer full SCARED questionnaires. Further QI processes are needed to improve follow-up of positive screens.

Percentage of 8-11 well child visits with anxiety screening by month
Average rate of anxiety screening at well child visits for patients aged 8 to 11 across 4 primary care clinics monthly after initiation of quality improvement project.