Background: Anxiety disorders are the most common behavioral issue in Pediatrics and often occur along with other behavioral illnesses including depression and ADHD. Not recognizing and treating these concerns can lead to long-term consequences that will negatively affect the lives of patients. Studies show 4 out of 5 children with behavioral/mental health issues do not receive the help they need. The goal of this project was to improve diagnosis, treatment, and management of behavioral health disorders in the General Pediatrics Clinic setting by October 2020 by improving resident comfort level with management, improving behavioral health follow-up, improving use of follow-up assessment tools, and improving referral to counseling. 

Methods: Data collected from 24 months of visits with patients who have ADHD, anxiety, or depression through chart review with set questions from the Behavioral Health in Pediatrics section of TNAAP. Residents were given lectures regarding behavioral health concerns and given a pre- and post-learning survey that assessed their comfort level with diagnosing, treating, referring, and following up with patients who have ADHD, anxiety, and depression. A handout and workflow with templates in EMR were also created to facilitate resident comfort. 

Results: Results were difficult to interpret due to the effect of COVID-19 pandemic on patient follow-up but did show an increase in follow-up with 33% increase in Routine Anxiety/ Depression follow-up, 36% increase in acute ADHD follow-up and 8% increase in Routine ADHD follow-up. Resident comfort level also improved. 

Conclusions: While follow-up did improve, there is a need to increase use of screening tools, referrals to behavioral health services, and resident comfort level with management. To ensure continued improvement we added reminders to EMR templates to complete evaluation tools and inquire about behavioral health follow-up. We will also continue to educate residents with the goal of continued improvement in this area.