Date of Award

Summer 7-25-2026

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

David Liguori, DNP, NP-C, ACHPN

Second Advisor

Leeann M. Blaskowsky, DNP, APRN, NNP-BC, C-ELBW

Abstract

Practice Problem: Adolescent depression is frequently under identified in pediatric primary care because of inconsistent implementation of routine depression screening despite national recommendations. This practice gap may delay diagnosis and treatment which may increase the risk of adverse mental health outcomes.

PICOT: The PICOT question that guided this project was: In pediatric primary care providers, how does the implementation of a standardized PHQ-A (Patient Health Questionnaire for Adolescents) workflow compared to informal screening practices affect provider adherence to depression screening guidelines over 12 weeks?

Evidence: Current evidence and national clinical practice guidelines support routine adolescent depression screening using validated tools such as the PHQ-A. Studies demonstrated that standardized workflows improve adherence and screening completion rates compared to informal practices.

Intervention: A standardized workflow was implemented during well-child visits for adolescents aged 12-17 years. Staff received education on the workflow, and the PHQ-A assessments were prepared according to the schedule at the beginning of the day and were administered during the rooming process once the patient arrived to promote consistent screening and documentation.

Outcome: PHQ-A screening compliance increased from 64.3% at baseline to 87.9% following implementation. Fisher’s Exact Test demonstrated a statistically significant improvement in provider adherence (p=.048), and the odds ratio of 3.95 indicated that adolescents were almost 4 times more likely to complete a PHQ-A after implementation.

Conclusion: Implementing a standardized PHQ-A workflow significantly improved provider adherence to evidence-based adolescent depression screening recommendations. This low-cost and sustainable intervention has the potential to improve early identification of depression and support high-quality preventative care.

Comments

Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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