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Checking IN: Development, Acceptability, and Feasibility of a Pediatric Electronic Distress Screener
Lori Wiener1, Sima Z Bedoya1, Mallorie Gordon1
1Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Insights
A new electronic tool, Checking IN, effectively screens psychosocial distress in pediatric patients with chronic illnesses. It is feasible, acceptable, and provides clinically useful data to inform care adjustments.
Area of Science:
- Pediatric healthcare
- Mental health screening
- Adolescent health
Background:
- Chronic illness in youth presents significant psychosocial challenges.
- Pediatric clinics face time and resource limitations for mental health assessments.
- A brief, real-time psychosocial assessment tool is needed for pediatric patients.
Purpose of the Study:
- To develop and evaluate an electronic distress screening tool, Checking IN, for pediatric patients aged 8-21.
- To assess the feasibility and acceptability of the Checking IN tool in busy outpatient clinics.
- To determine if the tool provides clinically useful information for patient care.
Main Methods:
- The Checking IN tool was developed in three phases, including cognitive interviews with patients and feasibility testing with patients, caregivers, and researchers.
- Phase I involved cognitive interviews (N=47) to refine item wording for emotional, physical, social, practical, and spiritual concerns.
- Phase III involved semi-structured interviews (N=134) across four sites to evaluate feasibility, acceptability, and barriers.
Main Results:
- Patients and caregivers found Checking IN easy to complete and feasible.
- The tool's completion time was deemed acceptable.
- Most providers (68/?) found the information clinically useful and novel, with 54% altering patient care based on results.
Conclusions:
- Checking IN is a versatile, brief, and acceptable distress screener for youth with chronic illnesses.
- The electronic tool provides immediate, clinically meaningful data for psychosocial wellbeing.
- Checking IN facilitates standardized assessment, triaging referrals, and psychosocial documentation in outpatient settings.
Objective:
Chronic illness in children and adolescents is associated with significant stress and risk of psychosocial problems. In busy pediatric clinics, limited time and resources are significant barriers to providing mental health assessment for every child. A brief, real-time self-report measure of psychosocial problems is needed.
Methods:
An electronic distress screening tool, Checking IN, for ages 8-21 was developed in 3 phases. Phase I used semi-structured cognitive interviews (N = 47) to test the wording of items assessing emotional, physical, social, practical, and spiritual concerns of pediatric patients. Findings informed the development of the final measure and an electronic platform (Phase II). Phase III used semi-structured interviews (N = 134) to assess child, caregiver and researcher perception of the feasibility, acceptability, and barriers of administering Checking IN in the outpatient setting at 4 sites.
Results:
Most patients and caregivers rated Checking IN as "easy" or "very easy" to complete, "feasible" or "somewhat feasible," and the time to complete the measure as acceptable. Most providers (n = 68) reported Checking IN elicited clinically useful and novel information. Fifty-four percent changed care for their patient based on the results.
Conclusions:
Checking IN is a versatile and brief distress screener that is acceptable to youth with chronic illness and feasible to administer. The summary report provides immediate clinically meaningful data. Electronic tools like Checking IN can capture a child's current psychosocial wellbeing in a standardized, consistent, and useful way, while allowing for the automation of triaging referrals and psychosocial documentation during outpatient visits.
