Checking IN : Development,Acceptability,and Feasibility of a Pediatric Electronic Distress Screener

Abstract

Objective:

Chronic illness in children and adolescents is associated with significant stress and risk of psychosocial problems. In busy pediatric clinics, limited time and resources are significant barriers to providing mental health assessment for every child. A brief, real-time self-report measure of psychosocial problems is needed.

Methods:

An electronic distress screening tool, Checking IN, for ages 8–21 was developed in three phases. Phase I used semistructured cognitive interviews (N = 47) to test the wording of items assessing emotional, physical, social, practical, and spiritual concerns of pediatric patients. Findings informed the development of the final measure and an electronic platform (Phase II). Phase III used semistructured interviews (N = 134) to assess child, caregiver and researcher perception of the feasibility, acceptability, and barriers of administering Checking IN in the outpatient setting at four sites.

Results:

Most patients and caregivers rated Checking IN as “easy” or “very easy” to complete, “feasible” or “somewhat feasible,” and the time to complete the measure as acceptable. Most providers (n = 68) reported Checking IN elicited clinically useful and novel information. Fifty-four percent changed care for their patient based on the results.

Conclusions:

Checking IN is a versatile and brief distress screener that is acceptable to youth with chronic illness and feasible to administer. The summary report provides immediate clinically meaningful data. Electronic tools like Checking IN can capture a child’s current psychosocial wellbeing in a standardized, consistent, and useful way, while allowing for the automation of triaging referrals and psychosocial documentation during outpatient visits.

Implications for Impact Statement

Manifestations of psychosocial distress may be missed by health care providers in the outpatient setting and opportunities for referrals lost. A multiphase study guided the development of Checking IN, a brief and interactive electronic screening measure designed to identify concerns common to pediatric patients. Checking IN was found to be feasible, acceptable, and clinically meaningful and has the potential to identify distress in children receiving treatment for a chronic condition, enhance communication with the treatment team, and lead to better clinical outcomes.