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Impact of implementing mental health screening by mail with a primary care management model
Lindsay R Hunter1, Brian A Lynch
1Mayo Clinic, Rochester, MN, USA.
Insights
Mailing the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) to screen young children for developmental disorders in primary care had a low return rate. While nurses can manage screening follow-up, mail-in questionnaires are not ideal for broad population screening.
Area of Science:
- Pediatrics
- Child Psychology
- Public Health
Background:
- Early identification of social and emotional disorders in children is crucial for school readiness.
- Standardized screening tools are often underutilized, leading to underdiagnosis.
- This study examines the implementation of the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) via mail in primary care for 30-month-old children.
Purpose of the Study:
- To describe the implementation process of the ASQ:SE mailed to children at 30 months of age in a primary care setting.
- To assess the effectiveness of mail-in screening for social and emotional disorders in young children.
- To analyze demographic factors associated with questionnaire completion.
Main Methods:
- The ASQ:SE was mailed to parents of all 30-month-old children receiving primary care.
- Clinical outcomes for children with elevated scores or parental concerns were extracted from electronic medical records.
- Demographic variables (race, insurance type) were analyzed for their association with mail-in completion rates.
Main Results:
- A 58.3% return rate was observed for the 870 mailed ASQ:SE questionnaires.
- 7.5% of children with returned screens required follow-up, and 1.2% were referred to Early Intervention.
- Parents with private insurance were more likely to return the questionnaire (65.5%) compared to those with government insurance (34.2%).
Conclusions:
- Registered nurses can effectively manage mental health screening follow-up protocols in primary care.
- Mailing the ASQ:SE is not an effective method for screening the majority of primary care populations.
- Alternative or supplementary methods may be needed to improve screening reach and effectiveness.
Background:
Early recognition and treatment of social and emotional disorders in children is significant for school preparation. These disorders are frequently underdetected without the use of standardized screening instruments. The purpose of our study is to describe the implementation of the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) in primary care practice by mail when children are 30 months old.
Methods:
In this 4-month study, parents of all 30-month-old children who receive primary care at our study site were mailed the ASQ:SE. In children who did not pass screening or received a call from a registered nurse for parental concerns documented on the questionnaire, short-term clinical outcomes were obtained from the electronic medical record. During the last month of the study, the demographics variables of race and insurance type were analyzed for an association with questionnaire completion by mail.
Results:
Of the 870 families mailed 30-month ASQ:SE screens, 507 (58.3%) were returned by mail. Out of the children with returned screens, 38 (7.5%) of parents were contacted for either elevated scores or concerning comments and 6 (1.2%) were referred to Early Intervention. Parents of children with government insurance returned the ASQ:SE questionnaire 34.2% (13/38) of the time compared with 65.5% (76/116) of those with private insurance (P < .001).
Conclusion:
Our results indicate that mental health screening can be effectively managed in primary care practice by a registered nurse using a follow-up protocol. Mailing the ASQ:SE is likely not an effective way to comprehensively screen most primary care populations.
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