Medical conditions can take a toll on a child’s mental health and quality of life. That’s why Atrium Health Levine Children’s implemented Checking IN, a mental health screening tool, in 2023. Levine Children’s was the first children’s hospital in the United States to apply Checking IN for clinical use and continues to be one of only a few hospitals in the country to use Checking IN clinically.
“Children with any chronic health condition, whether it’s diabetes or a heart transplant, can have their quality of life impacted by that condition,” says Amii C. Steele, PhD, chief of Levine Children’s Psychology & Neuropsychology. “That impact may be subtle or it may be significant. We want to make sure we’re assessing for mental health concerns so we can provide the support to help children succeed and thrive.”
The Importance of Mental Health Screenings
Children with certain medical conditions can face a 50 to 60% higher risk of developing mental health disorders. The National Comprehensive Cancer Network even designated emotional distress as the sixth vital sign for providers to recognize, document and treat at each patient visit.
“Making mental health screening a standard across all specialties at physical exams will allow us to reach all of our kids in specialty care,” says Steele. “Often, medical teams are not aware of a child's emotional distress until it becomes severe. This screening allows for early assessment and intervention with a vulnerable population of children.”
Developed by researchers in the Pediatric Oncology Branch of the National Cancer Institute (NIH NCI) and the National Institute of Mental Health (NIMH) and technology through Patient Planning Services & Cancer Support Community, Checking IN is an evidence-informed digital distress screening solution for children with medical conditions.
Thanks to the generous support and funding from the Duke Endowment, Levine Children’s launched Checking IN in 2023 for its cardiology, cancer, blood disorder and diabetes pediatric patients.
The Checking IN Screening Process
Checking IN screens for mental health concerns that may not come up during a standard medical visit. The program creates an integrated health model that works to identify mental health issues before they become severe and to connect pediatric patients to timely mental health services.
The screening gets specific: Patients between the ages of 8 and 21 respond to a brief, electronic questionnaire that assesses anxiety, depression, anger, sleep, pain, body image, family relationships and more. The 3- to 5-minute survey’s format and language are kid-friendly and age-appropriate, so children and adolescents can easily understand the questions and feel comfortable responding authentically. The screenings vary slightly by ages and are based on developmental level.
The survey not only asks children if they experience these issues, but also how much the symptoms impact their daily lives. The clinical team can review results from the screening summary immediately to provide a brief intervention or to make a referral to a pediatric psychologist.
“This tool has been really useful in helping medical providers understand their patients more comprehensively,” says Steele.
Checking IN’s Collaboration with Pediatric Endocrinology
In 2023, Levine Children’s endocrinology team began a partnership with the pediatric psychology team to transition from PHQ-9 depression screening forms to Checking IN’s mental health screenings using tablet technology. While patients wait for their physician to enter the exam room, they complete a questionnaire on a tablet, allowing the team to quickly identify patients who may have struggles they don’t always verbalize during an office visit.
“I love how the Checking IN screener can stratify areas of emotional concern,” says Dr. Mark Vanderwel, medical director of endocrinology at Levine Children’s. “For example, are there concerns about sleep? How about family relationships or school? This allows us to determine if we need to have a conversation with the parents outside of the room.”
Dr. Vanderwel adds that the Checking IN team has been instrumental in coordinating therapy intake and assessment for patients with emotional health concerns.
2023 Checking IN Findings
In 2023, the Checking IN program screened nearly 1,000 patients across Levine Children’s outpatient clinics.
Based on the results of the 2023 patient screenings, the Checking IN team found that 72.7% of patients expressed concern with one or more psychosocial domains. The top concerns impacting patients’ daily living were difficulties with fatigue, sleep, attention, anger, worry and school.
The implementation of Checking IN allows medical providers to learn new information about their patients that they otherwise may not have known and, at times, even adjust their treatment or care plan to meet the patient’s needs.
The screenings have been well-received by patients, families and providers, according to research published in Clinical Practice in Pediatric Psychology.
“In a pilot study, this screening has been as popular with patients’ families as it has been with medical providers,” says Steele. “Of families, 97% feel comfortable with this screening tool being administered at each visit and 97% of medical providers believe it’s a useful and important tool in caring for their patients.”
Checking IN: Looking Ahead
The Checking IN team plans to expand the program to additional subspecialty clinics in 2024.
“This is very much a group effort to serve our kids,” says Megan McComas, PhD, a psychologist with Levine Children’s Psychology and Neuropsychology. “We couldn’t have done this without the clinics and their teams, including the front desk staff, medical assistants, CNAs, nurses, social workers, advanced practice providers and physicians.”
Learn more about pediatric psychology at Levine Children’s.
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