Brief Clinical Needs Assessment Quality Check for EBP Adherence in pediatric primary care
Abstract
Introduction: Children's mental health is in crisis, with long waitlists and high rates of untreated mental health problems. It is critical that children receive care based on the highest quality research. Most mental professionals have limited training in the care of children under 6, increasing the importance of assessing their care. Practice guidelines published by pediatricians and child psychiatrists define best practices for young children under 6. The CHKD Mental Health Program has developed briefer guidelines organized by age, diagnosis, and impairment. This project examines the adherence to treatment guidelines for children under 6 at CHKD in the initial triage appointment. A secondary objective is to identify any differences in adherence by patient or clinician factors.
Methods: This study utilized a retrospective chart review of charts of children seen for an initial triage appointment between June 2023 to July 2024. The primary outcome was adherence to guidelines, assessed by linking documented diagnosis, level of impairment, and treatment plan, categorized as fully adherent, partially adherent, non-adherent. Weekly reliability discussions addressed specific charts and a second rater rated 85% for reliability. Moderator variables included age, race, language, diagnosis, insurance, and evidence of impairment across multiple domains.
Results: Overall, 67% (n=156) of the care plans fully adhered to published treatment guidelines An additional 27.5% (n=64) were partially adherent. Only 5.6% (n=13) of plans of care were not adherent.
Conclusion: First, most children seen for care receive treatment recommendations adherent to published guidelines There was no evidence of systemic disparities in care plans by age, race, gender, and insurance This project found evidence of possible judicious use of limited resources. Importantly, there was a high number of patients displaying symptoms of ADHD who did not receive a diagnosis and were referred to testing. This causes delays in care, as testing involves copious resources and time of mental health professionals This can result in longer wait time to receive therapy as well as to access psychiatrists for medication Quality improvement strategies may support patient outcomes and improve adherence to standard guidelines for treatment of patients under six Assessing professionals for levels of understanding of CHKD protocol guidelines for children under six Education via trainings and workshops to refresh knowledge of standard guidelines and clarify guidelines Integrating AI into Electronic Medical Records to streamline care management by automating treatment plan suggestions in line with protocol, further allowing practitioners to adhere to standard care plans Repeat trainings periodically and continually re-assess adherence to guidelines.