ETUDES Center Pilot Projects
2024-2026
Pilot Study to Inform the Development of Remote Symptom Monitoring to Improve the Management of Depression and Suicide Risk in Pediatric Primary Care: Jason D. Jones, PhD
Significance: Pediatric primary care has become a frontline setting for identifying and managing adolescent depression and suicidal thoughts and behaviors (STB). Most youth visit PC for annual medical check-ups (i.e., well visits), and Primary Care reduces several barriers associated with engaging in specialty mental health care, such as cost, stigma, and scarcity of appointments. A critical step toward early identification and monitoring of BH concerns has been the introduction of routine screening in Primary Care. The Guidelines for Adolescent Depression in Primary Care recommend universal screening for depression at annual well visits beginning at age 12 years and ongoing monitoring of symptoms in Primary Care for youth who endorse elevated symptoms. Guidelines for universal STB screening are unclear: the American Academy of Pediatrics recommends universal screening starting at age 12, whereas the United States Preventive Services Task Force concluded there is insufficient evidence to recommend universal suicide screening.
The ultimate goal of this work is to change and improve BH care in pediatric Primary Care by giving PCPs tools and procedures that will help them effectively monitor and manage symptoms without adding significant burden to patients or providers. Remote patient monitoring is a novel approach that is revolutionizing healthcare. Payors have responded to the remote patient monitoring revolution with updated billing codes for various types of remote monitoring. At CHOP, providers in several specialties have begun to use remote monitoring to manage both acute and chronic conditions using Care Companion. Yet, this approach has not been applied to managing mental health symptoms in Primary Care. Remote symptom monitoring is consistent with the overall mission of the ETUDES Center to use novel digital tools to augment the capacity of Primary Care to identify, manage, and treat youth at risk for depression and suicidal thoughts and behaviors. The proposed ETUDES Pilot has three aims:
Analyze longitudinal screening data from the CHOP ETUDES retrospective cohort (N = 198,005 PC patients) to better understand current symptom monitoring practices (timing, frequency), particularly for patients with a positive screen. With input from partners (see below), the data will also be used to identify patients “at-risk” who may benefit from additional monitoring and to select items that could be used in remote monitoring.
Conduct qualitative interviews with patients, caregivers, and providers (N = 30; 10 from each group) to inform the development of remote symptom monitoring tools and procedures. Guided by the Consolidate Framework for Implementation Research (CFIR),5 these interviews will assess perceived barriers and facilitators to remote monitoring in PC to inform future implementation.
Synthesize information and feedback from Aims 1 and 2 to present to ETUDES Engagement Groups (EEGs), CHOP’s Youth Advisory Council, and CHOP health system leaders to obtain feedback and guide next steps for pilot testing.
Jason Jones, PhD
Research Scientist, Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP
2023-2025
"Suicide in Children's Advocacy Centers": Elizabeth McGuier, PhD
Children’s Advocacy Centers (CACs) provide coordinated interagency responses to sexual abuse and other severe maltreatment. There are >950 CACs in the United States, covering 75% of counties and serving hundreds of thousands of children annually. Half of CACs serve mostly rural populations. In each CAC, a multidisciplinary team works together to conduct investigations and provide services after allegations of sexual abuse and other serious maltreatment. Team members include CAC staff (i.e., professionals employed by the CAC) and professionals employed by separate organizations in different systems (e.g., law enforcement, child welfare, mental health, advocacy). They have diverse expertise and vary in suicide prevention knowledge, comfort, and skill as well as power, authority, and access to resources. CAC teams are well-positioned to implement brief interventions24 and prevent suicide among youth served by CACs.
CAC teams include professionals from multiple disciplines (e.g., law enforcement, victim advocacy, mental health, child welfare) with varied training and experience in suicide prevention.8–10 Effective collaboration among team members with diverse expertise could be leveraged to mitigate suicide risk in vulnerable rural youth served by CACs. The objectives of this proposal are to 1) describe suicide prevention efforts in rural CACs, 2) use social network methods to visualize and describe how team members collaborate in suicide prevention efforts, and 3) identify facilitators and barriers to suicide prevention in rural CACs.
Results from this pilot study will inform the development of interventions and implementation strategies that leverage social networks to support suicide prevention in rural CACs.
Elizabeth McGuier, PhD
Assistant Professor of Psychiatry & Pediatrics, University of Pittsburgh
"Caring for Those Who Care for Our Kids": Karen Schwartz, PhD & Molly Davis, PhD
Suicide rates are on the rise, particularly among Black youth. Pediatric primary care is a natural front-line care setting to identify youth at risk for depression and suicide. The Children’s Hospital of Philadelphia (CHOP) serves a high proportion of families who identify as ethnic and/or racial minorities and has put in place routine screening for suicide and depression in primary care. Research suggests that a large proportion of youth have not spoken to their caregivers about their suicidality prior to these screenings, so they may be very surprised to learn about what their teen is going through at these visits. The understandable emotional response among caregivers may make it difficult for them to manage their teen’s crisis. Thus, we need to attend to the needs of caregivers to better prepare them to support their teens at this important time. Thus, the purpose of the study is to use qualitative methods to inform the design of a caregiver-facing intervention for caregivers of teens endorsing suicide risk on a depression screener administered during primary care well visits. Specifically, we hope to (a) identify intervention targets, as well as barriers and facilitators to intervention engagement and implementation from the perspectives of impacted community partners (parents, adolescents), and (b) synthesize partner feedback to create a low-fidelity mockup of a caregiver-facing intervention, which will be presented to ETUDES engagement group members (parents, providers, healthcare leaders) for further feedback, particularly with an eye towards sustainable implementation of the brief intervention in primary care.
Karen Schwartz, PhD
Clinical Psychologist, Children’s Hospital of Philadelphia
Molly Davis, PhD
Research Psychologist, Department of Child & Adolescent Psychiatry & Behavioral Sciences, Children’s Hospital of Philadelphia
Assistant Professor of Psychiatry, Perelman School of Medicine, University of Pennsylvania