Date of Completion
Fall 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
Abstract
Problem: A practice gap existed in a rural primary care clinic where adolescents aged 12–18 years were not routinely screened for depression during annual well-child visits. A retrospective review of 22 adolescent charts identified no routine PHQ-9 screenings during well-child visits, establishing a baseline routine screening rate of 0%.
Aim of the Project: The aim was to implement a standardized Patient Health Questionnaire-9 (PHQ-9) screening process and increase routine depression screening to at least 90% of eligible adolescents while achieving documented follow-up within 14 days for at least 85% of adolescents with positive screens.
Review of the Evidence: Evidence supports standardized adolescent depression screening using validated tools such as the PHQ-9 to improve early identification. Successful implementation is strengthened by integration into clinical workflows, staff education, and established referral and follow-up pathways.
Project Design: This quality improvement project used the Institute for Healthcare Improvement Model for Improvement and Plan-Do-Study-Act cycles to evaluate and refine the practice change. The OhioHealth Change Management Model supported stakeholder engagement, education, communication, and sustainability.
Intervention: A standardized PHQ-9 screening and referral protocol was integrated into the clinic’s paper-chart workflow. Nurses and providers received education regarding PHQ-9 administration, scoring, documentation, suicide-risk assessment, and appropriate follow-up. Positive screens prompted provider evaluation and follow-up.
Significant Findings/Outcomes: Routine PHQ-9 screening increased from 0% at baseline to 100% following implementation. All 15 eligible adolescents were screened, exceeding the 90% goal. Three adolescents (20%) screened positive, and all three received in-house mental-health follow-up within 14 days, achieving a 100% follow-up rate and exceeding the 85% goal. Provider and nurse training reached 100%.
Implications for Nursing: Standardized PHQ-9 screening can strengthen nurses’ role in early identification of adolescent depression, communication of positive findings, documentation, and coordination of timely follow-up. Continued staff education, clearly defined responsibilities, periodic chart audits, and PDSA cycles can support sustainability.
Recommended Citation
Shaw, Eleanor, "Improving Screening and Referral of Adolescent Depression in Pediatric Primary Care" (2026). All Doctor of Nursing Practice (DNP) Scholarly Projects. 89.
https://fuse.franklin.edu/dnp-project/89
Rights
Copyright, all rights reserved
Included in
Community Health and Preventive Medicine Commons, Family Practice Nursing Commons, Mental Disorders Commons, Pediatric Nursing Commons, Public Health and Community Nursing Commons
