From Planning to Implementation: Creating and Adapting Universal Screening Protocols to Address Caregiver Mental Health and Psychosocial Complexity

Objective: Children are accompanied to primary care settings by caregivers who present with their own mental health and psychosocial distress. Primary care is an optimal place to identify negative impacts on child health. Clinics with integrated behavioral health (IBH) clinicians are well-positioned to implement and respond to caregiver screenings. Methods: Universal screening to address perinatal mood and anxiety disorders (PMADs) and psychosocial distress was implemented in 3 primary care clinics within 1 hospital system. Pediatric psychologists supported implementation across all clinics. Screening frequencies, average scores of elevated screeners, and most common treatment recommendations made by IBH clinicians were extracted from medical records. Results: Universal caregiver screening effectively identified mental health and psychosocial concerns and was a driver of increased behavioral health access in pediatric primary care. A total of 6,080 caregivers were screened over 3 years. Results showed 10% and 16.4% of caregivers had elevated PMADs screening results, 33% to 46% identified social determinants of health needs, and 6.6% to 11.5% identified mental health concerns. Responses to screeners including follow up with the IBH team, brief interventions, and caregiver referral to mental health services. Conclusions: Caregiver screening is an essential component of comprehensive well-child care. Without universal screening processes, caregiver mental health and psychosocial concerns may go undetected and unaddressed. Implications for Impact StatementThis paper describes the importance of screening caregivers for behavioral health concerns and psychosocial adversity during pediatric primary care visits. The role of pediatric psychologists in developing universal screening protocols is described. Results indicate that caregiver screening yields increased behavioral health involvement.