Title: Approved Behavioral Health Screening Tools for 3Ai and 4Aiii
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Title: Approved Behavioral Health Screening Tools for 3ai and 4aiii Date Created: 10/8/2015 Date Modified: 07/27/2017 Date Approved by Board of Directors: 11/10/2015 Clinical Guideline # CGC-CG-26 Purpose: The purpose of this guideline is to establish a menu of approved behavioral health screening tools for use in the 3ai Integration of Behavioral Health and Primary Care (Model 1) project and 4aiii Strengthening Mental Health and Substance Abuse Infrastructure Across Systems. Participating practices may choose from the menu of approved screening tools below or use nationally-accepted best practice that are determined to be aged-appropriate: Approved Screening Tools: Depression: PHQ-9: Patient Health Questionnaire (9 questions) PHQ-2: Patient Health Questionnaire (2 questions) Anxiety: GAD-7: General Anxiety Disorder (7 questions) Substance CAGE-AID: Cut-down, Annoyed, Guilty, and Eye-Opener (4 questions) Abuse: CAGE: 4 questions AUDIT: Alcohol Use Disorder Identification Test (10 questions) DAST- 10: Drug-Abuse Screening Test (10 question; excludes alcohol) CRAFFT: Series of 6 questions to identify adolescents 14- 21 years of age for risky alcohol and other drug use disorders NIAAA: 3 question screen Trauma: PC-PTSD: Primary Care- Post Traumatic Stress Disorder (for veterans) PCL-C: Abbreviated PTSD Checklist, Civilian Version Suicide or Nursing Assessment for Suicide/Violence (4 questions) Violence: If appropriate, followed by: Suicide Assessment (23 questions) Violence Assessment (23 questions) BH Works: BH Works, a tablet-based screening IT solution has a “smart” assessment tool which covers 13 domains of behavioral health. SBIRT: Screening, Brief Intervention and Referral to Treatment is an evidence based practice. Staff must be certified/ trained in SBIRT prior to administering SBIRT. Additional screenings such as AUDIT, DAST or CRAFFT may be warranted for further assessments. Integrating Behavioral Health and Primary Care—Approved Behavioral Health Screening Tools Page 1 of 2 Pediatrics: Pediatric Symptom Checklist –(PSC) is a brief screening questionnaire used by pediatricians and other professionals to improve early detection and interventions of psychosocial problems in children. Clinical Guideline Board Approval History: 11/10/2015 Clinical Guideline Revisions: Date Revision Log Updated by 10/8/2015 Initial Draft E. Pape 09/09/2016 Incorporated 4aiii Strengthening B. Rosetti Mental Health and Substance Abuse. Project and CAGE screening. Added SBIRT, NIAAA, CRAFFT screening 10/19/2016 Added Pediatric Symptom B. Rosetti Checklist (PSC) 01/13/2017 To align with DOH’s minimum B. Rosetti standards: Added PHQ-2 and incorporated all behavioral health screenings that are nationally-accepted best practice that are determined to be aged- appropriate 07/06/2017 and 07/27/2017 Annual Review – No changes. B. Rosetti CGC members agreed that partners should be allowed to use nationally-accepted best practice screenings that are aged- appropriate. This Clinical Guideline shall be reviewed periodically and updated consistent with the requirements established by the Board of Directors, Care Compass Network’s senior management, Federal and State law(s) and regulations, and applicable accrediting and review organizations. Integrating Behavioral Health and Primary Care—Approved Behavioral Health Screening Tools Page 2 of 2 PHQ-9 Patient Depression Questionnaire For initial diagnosis: 1. Patient completes PHQ-9 Quick Depression Assessment. 2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive disorder. Add score to determine severity. Consider Major Depressive Disorder - if there are at least 5 3s in the shaded section (one of which corresponds to Question #1 or #2) Consider Other Depressive Disorder - if there are 2-4 3s in the shaded section (one of which corresponds to Question #1 or #2) Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient. Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social, occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms. To monitor severity over time for newly diagnosed patients or patients in current treatment for depression: 1. Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at home and bring them in at their next appointment for scoring or they may complete the questionnaire during each scheduled appointment. 2. Add up 3s by column. For every 3: Several days = 1 More than half the days = 2 Nearly every day = 3 3. Add together column scores to get a TOTAL score. 4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score. 5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of response, as well as guiding treatment intervention. Scoring: add up all checked boxes on PHQ-9 For every 3 Not at all = 0; Several days = 1; More than half the days = 2; Nearly every day = 3 Interpretation of Total Score Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a trademark of Pfizer Inc. A2662B 10-04-2005 PATIENT HEALTH QUESTIONNAIRE (PHQ-9) NAME: DATE: Over the last 2 weeks, how often have you been bothered by any of the following problems? More than Several Nearly (use "ⁿ" to indicate your answer) Not at all half the days every day days 1. Little interest or pleasure in doing things 0 1 2 3 0 1 2 3 2. Feeling down, depressed, or hopeless 0 1 2 3 3. Trouble falling or staying asleep, or sleeping too much 0 1 2 3 4. Feeling tired or having little energy 0 1 2 3 5. Poor appetite or overeating 6. Feeling bad about yourself or that you are a failure or 0 1 2 3 have let yourself or your family down 7. Trouble concentrating on things, such as reading the 0 1 2 3 newspaper or watching television 8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so figety or 0 1 2 3 restless that you have been moving around a lot more than usual 9. Thoughts that you would be better off dead, or of 0 1 2 3 hurting yourself add columns + + (Healthcare professional: For interpretation of TOTAL, TOTAL: please refer to accompanying scoring card). 10. If you checked off any problems, how difficult Not difficult at all have these problems made it for you to do Somewhat difficult your work, take care of things at home, or get Very difficult along with other people? Extremely difficult Copyright © 1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD© is a trademark of Pfizer Inc. A2663B 10-04-2005 GeneralizedAnxietyDisorder7-item(GAD-7)scale Overthelast2weeks,howoftenhaveyoubeen Notat Several Overhalf Nearly botheredbythefollowingproblems? allsure days thedays everyday 1.Feelingnervous,anxious,oronedge 0 1 2 3 2.Notbeingabletostoporcontrolworrying 0 1 2 3 3.Worryingtoomuchaboutdifferentthings 0 1 2 3 4.Troublerelaxing 0 1 2 3 5.Beingsorestlessthatit'shardtositstill 0 1 2 3 6.Becomingeasilyannoyedorirritable 0 1 2 3 7.Feelingafraidasifsomethingawfulmight 0 1 2 3 happen Addthescoreforeachcolumn + + + TotalScore(addyourcolumnscores) = Ifyoucheckedoffanyproblems,howdifficulthavethesemadeitforyoutodoyourwork,take careofthingsathome,orgetalongwithotherpeople? Notdifficultatall__________ Somewhatdifficult_________ Verydifficult_____________ Extremelydifficult_________ Source:SpitzerRL,KroenkeK,WilliamsJBW,LoweB.Abriefmeasureforassessinggeneralizedanxiety disorder. ArchInernMed. 2006;166:1092-1097. CAGE-AID Overview The Cage-AID is a conjoint questionnaire where the focus of each item of the CAGE questionnaire was expanded from alcohol alone to include alcohol and other drugs. Clinical Utility Potential advantage is to screen for alcohol and drug problems conjointly rather than separately. Scoring Regard one or more positive responses to the CAGE-AID as a positive screen. CAGE-AID Questionnaire Patient Name ______________________________________ Date of Visit _________________ When thinking about drug use, include illegal drug use, and the use of prescription drug use other than prescribed Questions: YES NO 1. Have you ever felt that you ought to cut down on your drinking □ □ or drug use? 2. Have people annoyed you by criticizing your drinking or drug use? □ □ 3. Have you ever felt bad or guilty about your drinking or drug use? □ □ 4. Have you ever had a drink or used drugs first thing in the morning □ □ to steady your nerves or to get rid of a hangover? CAGE Questionnaire CAGE Questionnaire • Have you ever felt you should Cut down on your drinking? • Have you ever felt you should Cut down on your drinking? • Have people Annoyed you by criticizing your drinking? • Have people Annoyed you by criticizing your drinking? • Have you ever felt bad or Guilty about your drinking? • Have you ever felt bad or Guilty about your drinking? • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? hangover (Eye opener)? Scoring: Scoring: Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant. problems. A total score of 2 or greater is considered clinically significant. ……………………………….. ……………………………….. Developed by Dr. John Ewing, founding Director of the Bowles Center for Alcohol Studies, Developed by Dr.