Screening Wizard, Component 1 of iCHART (Integrated Care to Help At-Risk Teens)-Feasibility/Pilot Phase
Condition: Depression; Suicidal Ideation
MeSH terms: Suicidal Ideation
Study type: Interventional

Summary: 
      Screening Wizard (SW). Primary Care Providers (PCPs) are often uncertain about how to best
      refer adolescents who screen positive for depression or suicidality. Screen-positive youth
      who are either not in treatment, or express dissatisfaction with current treatment will be
      consented by an on-site research assistant (RA). Those parents and patients receiving SW will
      answer additional questions: adaptive screens developed in a previous NIMH study (MH100155)
      for suicidal risk, anxiety, and mania; perceived barriers; and preferences about treatment.
      SW generates recommendations for PCPs reflecting patient clinical needs and preferences.
    

Detailed description: 
      Screening Wizard will be delivered by Primary Care Providers (PCPs) at well child visits,
      beginning with screening occurring within the waiting room which will yield decision support
      guidance delivered and followed by the PCP at that same visit.

      This study utilized an open trial design. A stepped wedge design was originally proposed and
      efforts were made to adhere to this study design, however after a year of low recruitment and
      resultant recruitment sites pulling out the of the study, the overall study design was
      changed to an open trial. Additional recruitment sites were onboarded to the study and
      provided with the intervention arm in order to obtain feasibility data on the intervention
      components of the study. For reference a stepped wedge design involves the sequential random
      rollout of an intervention over two time periods. Following a baseline period in which no
      clusters (=practices) are exposed to the intervention, the crossover is typically in one
      direction, from control to intervention and continues until both of the clusters have
      crossed-over to receive the intervention, with observations taken from each cluster and at
      each time period.

      Hypothesis: The use of Screening Wizard will increase the rate of personalized referrals
      experts in specialty mental health would provide, compared to Treatment as usual (TAU).
    

Intervention name(s): Screening Wizard
Intervention type(s): Behavioral
Intervention description(s): Screening Wizard is a decision support tool to guide the primary care provider to make a referral that reflects patient clinical needs and patient and parental treatment preferences and perceived barriers to treatment.
Intervention model: Single Group Assignment
Intervention model description: Ultimately, this study design was an open trial after unsuccessful attempts to maintain initial recruitment sites in the study.
This study initially attempted to use a stepped wedge design, which involves the sequential random rollout of an intervention over 2 time periods. Following a baseline period in which no clusters (= practices) are exposed to the intervention, the crossover is typically in one direction, from control to intervention and continues until both of the clusters have crossed-over to receive the intervention, with observations taken from each cluster and at each time period.
Masking: None (Open Label)
Primary purpose: Health Services Research