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Portals for screening patients for mental health and behavior problems: update 2022

Contemporary PEDS Journal, September 2022,

How online screening portals can help optimize your practice.

Many pediatric practices use paper questionnaires to screen patients for developmental concerns, such as autism, attention-deficit/hyperactivity disorder (ADHD), depression and anxiety, and high-risk behaviors, as recommended by the American Academy of Pediatrics.

What follows are some computer- and tablet-accessible portals that will facilitate office-based screening, expediting your visits while providing actionable information.

The CHADIS online portal

In 2001, 2 developmental pediatricians Barbara Howard, MD, and Raymond Sturner, MD, developed the Child Health and Development Interactive System (CHADIS), a comprehensive web-based system for screening children for behavioral and developmental problems. The CHADIS online portal has received more than $24 million in federal and foundation grants for research and development. To date, more than 5000 providers from around the globe are using the CHADIS system, and it continues to grow in features and popularity.

The CHADIS assessment tool allows pediatricians to invite parents to fill out age-appropriate screening tools online in advance of well-child visits. The CHADIS system evaluates the forms filled out by parents, performs scoring when indicated, and alerts pediatricians of issues that need to be discussed with parents during well-child or behavior-related visits. Many pediatricians speak favorably of the CHADIS system because it allows them to identify parental concerns and behavior issues that would have gone unidentified in the past. A CHADIS subscription costs approximately $1500 per provider per year, with discounts available for volume licenses.

CHADIS incorporates hundreds of screening tools that pediatricians utilize frequently, such as the Modified Checklist for Autism in Toddlers, Revised with Follow-up; Ages and Stages Questionnaires; Vanderbilt Assessment Scales; Patient Health Questionnaire for Adolescents; and Generalized Anxiety Disorder 7-item forms. It also provides a full library of resources to assist in management once a condition is diagnosed.

Mehealth for ADHD

A clinical study demonstrating that an internet portal could improve ADHD care was published by researchers affiliated with Cincinnati Children’s Hospital Medical Center in Ohio in 2011.1 The study demonstrated significantly higher rates of completed ADHD evaluations when the portal was used to expedite diagnosis.

The portal was later commercialized, as mehealth for ADHD. Parents seeking an evaluation are enrolled in the online portal at the time of a visit or over the phone, and then they receive an email with an activation code from the practice that provides access to the portal.

Parents fill out an initial medical history form as well as Vanderbilt screening forms. Subsequently, parents invite their child’s teachers to the portal to fill out Vanderbilt forms. Once completed, all forms are scored and are available in the patient’s mehealth for ADHD record, and an email is sent to the physician to alert them that a completed record is available for review. A report is generated with detailed interpretation. This facilitates the discussion of the diagnosis with parents at the follow-up visit. If a child is placed on medication, questionnaires are automatically sent to parents and teachers at preselected intervals (eg, usually every 1 to 3 months) to help monitor the response to treatment and alert providers of any symptoms suggesting adverse medication effects. Best of all, mehealth for ADHD is a free service, sponsored by a National Institutes of Health grant.

Best-kept secret in mental health screening: outcome referrals

David Kraus, PhD, has been working diligently for the past 30 years developing a universal screening tool for children, adolescents, and adults. His Treatment Outcome Package (TOP) consists of 58 questions for adults and adolescents and 48 questions for children, and it takes less than 10 minutes to complete. The TOP can be administered online or via a paper form, with results available immediately when submitted electronically and within 15 minutes when submitted by fax.

The TOP screens adolescents and children for suicidal ideation, violent behavior, psychosis, depression, ADHD, conduct problems, school and work problems, substance abuse, and others. In children, it also screens for eating disorders and anxiety. It is available via WellnessCheck.net, which facilitates the process of enrolling patients and parents, expediting completion of questionnaires. Questionnaires can be completed via tablet at the time of the patient encounter or via an email or a short message service text, which can be sent to the patient or parent to be completed on their own smart device. An alert is issued to the provider when a questionnaire is completed, and regular messages are sent if a requested questionnaire is not filled out. The service uses a prescription model and is available for less than $100 per provider per month.

The TOP has been validated in many clinical studies, showing that it is as effective as—if not more effective than—standard screening tools.2,3 Repeated testing during counseling shows how well the patient has responded to therapy and identifies areas that need more work. It is now being used by more than 30,000 therapists, and more than 1 million screens have been performed to date.

Kraus has used the TOP to develop a system that has identified therapists who are particularly good with certain problems (ie, excellent in treating anxiety but poor in treating substance abuse) to find the best therapist for a particular patient. Kraus’ study published in 2021 indicates better outcomes can be achieved in a shorter period when patients are matched with the most appropriate therapists.4 In fact, better-performing therapists are being compensated at higher rates from some insurance companies because the system provides an objective measure of results.

Fast-tracking autism diagnosis

Canvas Dx, an artificial intelligence–based system created by Cognoa that expedites the diagnosis of autism in children aged 18 months to 6 years, is now FDA-approved (full disclosure—I serve as a consultant for Cognoa to help improve its system).

Parents and providers fill out brief questionnaires, and parents upload several videos of children to the Canvas Dx website for analysis. Canvas Dx then renders 1 of 3 results: positive screen for autism, negative screen for autism, or screen inconclusive. A positive screen enables a child to receive necessary advanced behavioral analysis therapy. Usually, there is a waiting list of many months before a child can be seen by a developmental pediatrician or other expert who can make the diagnosis. In contrast, Canvas Dx can be completed in a matter of weeks.

Obstacles and conclusions

To use any of the portals described in this article, providers and staff need to be trained on the system and a workflow needs developed and tested to make sure things go smoothly. Successful use of these portals also requires that physicians be consistent with encouraging patients to fill out forms in advance of visits whenever possible.

Over the next few years, it is likely that more and more services will be available via specialized portals like those described in this article.

References:

1. Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics. 2011;128(5):e1201-1208. doi:10.1542/peds.2011-0872

2. Baxter EE, Alexander PC, Kraus DR, Bentley JH, Boswell JF, Castonguay LG. Concurrent validation of the Treatment Outcome Package (TOP) for children and adolescents. J Child Fam Stud. 2016;25:2415-2422. doi:10.1007/s10826-016-0419-4

3. Youn SJ, Kraus DR, Castonguay LG. The treatment outcome package: facilitating practice and clinically relevant research. Psychotherapy (Chic). 2012;49(2):115-122. doi:10.1037/a0027932

4. Constantino MJ, Boswell JF, Coyne AE, Swales TP, Kraus DR. Effect of matching therapists to patients vs assignment as usual on adult psychotherapy outcomes: a randomized clinical trial. JAMA Psychiatry. 2021;78(9):960-969. doi:10.1001/jamapsychiatry.2021.1221