Quality Improvement in Pediatrics: Survey Needs Assessment for Ambulatory Pediatric Specialties (SNAAPS)

Abstract

Objective:

This article describes a pediatric quality improvement (QI) initiative designed to improve access to behavioral health (BH) care across pediatric specialty clinics. Mental health concerns and chronic health conditions are undertreated in American youth. By implementing a robust biopsychosocial model of care, behavioral health integration (BHI) across pediatric specialty clinics provides opportunities to address mental health concerns, reduce access barriers to mental health care, decrease mental health stigma, improve care continuity, and increase effectiveness of medical care provided.

Method:

The Survey Needs Assessment in Ambulatory Pediatric Specialties (SNAAPS) was developed and implemented within the pediatric QI initiative following the Plan, Do, Study, Act (PDSA) cycle. The SNAAPS was used to assess medical provider identification of challenging mental health concerns and perceived need for BHI.

Results:

Results were shared with department stakeholders to inform new integration efforts. Providers reported highest demand for BHI to address issues of depression, anxiety, distress regarding medical diagnosis and treatment, and treatment adherence. Providers reported several BH concerns created barriers to effective medical care and providers only sometimes felt successful in overcoming these barriers to conducting medical care.

Conclusions:

Demand for BHI was clear across many specialties. Using the SNAAPS as part of the PDSA cycle was a useful process to inform new BHI efforts and therefore facilitate improved effectiveness and quality of health care.

Implications for Impact Statement

This study provides an organizational model and needs assessment survey that can be used to improve access to behavioral health care across pediatric specialty clinics. Results demonstrated that pediatric specialty providers identified several behavioral health concerns that created barriers to their patients’ medical care, which could be addressed by integrating behavioral health services directly into pediatric specialty clinics. Further, using the SNAAPS within the quality improvement context (following the PDSA cycle) was a useful strategy to increase access to behavioral health care in an evidence-based, resource-sensitive way.