Beating the blues: Improving depression screening rates in two FQHCs

The homeless population experiences depression at substantially higher rates than the general public (APA, 2015). When a client suffers from unidentified and untreated depression, it can be difficult - if not impossible - to improve that person's health or housing status. Starting in 2014, clinicians and leaders in Baltimore and Denver identified depression screening and referral to treatment as a high-priority quality improvement issue. Clinicians at both centers designed different interventions using the two-question screening and nine-question assessment Patient Health Questionnaires (PHQ-2, PHQ-9), two evidence-based tools that are designed to screen, diagnose, and assess depression in a primary care setting. This workshop will explore the importance of depression screening in an integrated medical home, the opportunities that PHQ tools create for both primary care and behavioral health providers, and the potential impact of effective screening on clients' health. It will compare and contrast the approaches used in Denver and Baltimore and will detail specific, replicable procedures for improving depression screening among patients that can be implemented in any health center. The panelists will share the challenges they faced in implementing the PHQ, which included explaining the screening process to clients, identifying workflows that do not negatively impact the provider/client encounter, and creating proper follow up protocols for positive screens. The workshop will focus on integrated, interdisciplinary care, and will address the work of support staff, medical assistants, PCPs, behavioral health consultants, psychiatrists, and mental health therapists in collaborating on patient-centered interventions. The presenters will also share pre- and post-intervention data that aligns with the UDS quality measure on depression screening and explain how their work helped improve these quality scores. Finally, the workshop will look at the PHQ screening tools, discuss challenges they present for a homeless population, and explore the solutions that clinicians in Baltimore and Denver identified to make the tools more effective and meaningful.