This proposal presents innovations to addressing teen depression during routine check-up visits through further development of an online clinical process support system called CHADIS. The primary care provider remains in the center of the process with his/her prior relationship with the family and humanity enabled with computer assistance prior to the encounter as well as moment of care reminders and teleprompted specific hints aimed at enhancing a patient focused balanced discussion of individual strengths and barriers to the teens goals known as a motivational interview. This is made feasible through pre-visit data collection providing relevant details to highlight as well as data to support omitting some traditional guidance areas with lower priority for the individual teen. Any conclusions coming from PCP recommendations and shared decision making is reinforced by a computer-based, always available chatbot guided by artificial intelligence that serves as a bridge to other helping professionals, strengths building resources, as well as conversations based on proven mental health therapies based on earlier pilot data for reducing depressive symptoms. These innovations will be tested via a cluster randomized control trial, demonstrating whether use of the system results in higher rates of screening, reductions in depressive symptoms, and accessing of evidence-based treatment for teen depression. Use of the system is reinforced by engagement of primary doctors and child psychiatrists in a related quality improvement program with data from their participation providing needed feedback for recertification of professional status requirements of their respective specialty boards. Success of the system would mean a new primary care workflow-friendly tool which could help adolescents avoid the significant functional impairment and increased risks that accompany teen depression. If this new paradigm for adolescent health supervision proves useful for depression, adaptations for other teen challenges might also be promising.
Approximately 12.5% of U.S. 12-17 year olds had at least one major depressive episode in the past year. Yet, up to 70% of teens with mental health (MH) care needs do not receive necessary care. This proposal addresses the significant public health problem of teen depression through use of a comprehensive, process-driven intervention targeting time points before, during, and after routine visits with primary care providers (PCPs) through a new module to an online clinical process support system called CHADIS.
