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Asking the Right Questions: Implementing Behavioral Health Screening in a Pediatric Emergency Department

 

Jessica Williams wants you to know that depressed kids don’t have a “look”. As the lead social worker in charge of the behavioral health screening protocol at Nemours/Alfred I duPont Hospital for Children, it’s her job to educate clinicians, staff, and families about the one thing they can do to identify kids in crisis: ask them the right questions. “Kids that appear to be depressed, whatever you think that might look like, they might not actually be depressed,” she explains. “And sometimes the kid with a suicide plan has tons of friends and makes straight A’s. We can’t make assumptions based on how a child appears.”

As “champion” of the screening protocol, Williams manages and evaluates the program, working concurrently with stakeholders at the Delaware Department of Services for Children, Youth, and Their Families. The protocol, which aims to screen all patients 12 years of age and older who are admitted to the emergency room, is first triggered when a nurse receives a best practice alert (BPA) through the hospital’s EHR system. The nurse then asks the patient to complete a behavioral health assessment on an iPad using a software program called BH-Works. This web-based survey asks patients questions about depression, trauma, substance use disorder, bullying, abuse, suicidal ideation, and gun access. Responses are automatically scored, summarized, and ready for review in the EHR, helping providers determine when a patient requires additional support. As a licensed clinical social worker, Williams also provides in-person clinical mental health assessments for patients who screen positive for risk.

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