INTRODUCTION: Pregnancy provides a unique opportunity to identify women exposed to risky behavior. Standardization has proven to decrease variability and improve quality of care across a breadth of disciplines. We aimed to increase screening and detection of behavioral health risks by introducing the standardized Integrated Screening Tool (IST). The IST uses 11 yes or no questions to screen for patient, peer and family substance use, domestic violence, and emotional health, and takes less than 3 minutes to complete. METHODS: We retrospectively reviewed 100 charts to evaluate baseline rates of screening. No standard tool was used at baseline. In January 2018, we launched universal screening using the IST at intake, 28-week, and 36-week visits within the Maternal-Fetal Medicine ambulatory clinic. Clinical staff instructed all patients to complete the IST while awaiting the provider. We reviewed 186 active patients' charts from January to July 2018. RESULTS: During the study period, 295 screening visits occurred. Chart review of these visits revealed 90% of opportunities to screen were completed compared to only 65% at baseline. Positive screens were significantly higher at intake and 28-week visits than when compared to baseline (33% vs 16% [P=.006], and 26% vs 11% [P=.017], respectively). CONCLUSION: Our data demonstrate a standardized, written tool increases screening in our patient population and significantly increases the detection of positive screens in pregnant patients. Identification of behavioral health risks in pregnancy can lead to potential interventions to mitigate the effect of these behaviors.
INTRODUCTION: Provider bias plagues behavioral health screening in pregnancy. One in three pregnant women will utilize illicit substances, experience depression/anxiety, or be a victim of violence. Following our Phase I results presented in 2019, we aimed to develop a standardized algorithm for providers to guide response to positive behavioral health screens. METHODS: Through an IRB approved protocol, we screened 260 patients at three intervals during pregnancy between January and June 2019. Patients in a Maternal Fetal Medicine clinic voluntarily completed the Integrated Screening Tool at three separate encounters. A novel, evidence-based algorithm was developed and utilized to guide provider response to a positive screen. RESULTS: During the study period, 479 eligible screening visits occurred among 260 patients. Compared to Phase I, indicated urine drug screen (UDS) completion increased from 13% to 80% (P<.001), of which 11% were positive. Across the screening intervals, 65% of patients with an initial positive screen, subsequently answered negative. Of the patients who initially screened negative, 25% had a positive screen later in pregnancy, of which 33% UDS were positive. Referral to mental health services for patients with a positive emotional health screen increased by 100% following implementation of the algorithm (P<.002). CONCLUSION: Utilizing a standardized algorithm guiding provider response to behavioral health screening in pregnancy significantly increased provider action yet did not identify a significant increase in detecting patients using illicit substances. Longitudinal screening is important as patients are likely to change their response. Additional study is indicated to further establish validity of this novel algorithm.
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