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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Small Business Innovation Research Grants (SBIR) - Phase II (R44)
Project #
4R44MH116751-02
Application #
10019727
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Haim, Adam
Project Start
2020-07-01
Project End
2023-06-30
Budget Start
2020-07-01
Budget End
2021-06-30
Support Year
2
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Total Child Health, Inc.
Department
Type
DUNS #
162789965
City
Baltimore
State
MD
Country
United States
Zip Code
21210