1 Screening Mental Health In Primary Care: Cradle to Grave Toolkit Mary R. Talen, Ph.D. Director, Behavioral Health Science MacNeal Family Medicine Berwyn, IL Christine Muller-Held, M.A. Bethesda Family Medicine Cincinnati, OH 45212

2 Objectives Understand a foundation for Mental Health Assessment, Promotion, and Intervention Identify Screening Tools for Mental Health Assessment Practice Administering and Scoring a screening tool Teaching Opportunities and Practice Management Applications

3 Introduction

4 Why Assess Mental Health in Primary Care? Biopsychosocial Model is central to Family Medicine Research: Significant correlations between biomedical diseases and psychological functioning Health Promotion, Primary Prevention and Disease Management are significantly related to Health Behaviors

5 Why Assess Mental Health? 25-33% of patients in primary care do have a mental health disorder. Mental Disorders are under detected in primary care Silent heartache syndromes Early intervention predicts better prognosis Limited use of screening tools

6 Overview Mental Health Screening Tools Seniors Adult Men Women Adolescent Pediatric

7 Senior Mental Health Screening Tools Montreal Cognitive Assessment (MoCA) Mini Mental Status (MMSE) Aid to Capacity and Competency Assessment

8 Senior Screening: MoCA Purpose: First line detection of mild cognitive impairment (MCI). Working memory Use of mental images Attention and speed Naming Executive Function Cognitive flexibility Administration: 10 minutes Scoring

9 MoCA vs MMSE Nasreddine, et..all JAGS, 2005, 53, MMSEMoCA Sensitivity (MCI v. NC) 29%84% Specificity (MCI v. NC) 71%83%

10 Adult Mental Health Screening Tools Patient Health Questionaire (PHQ-9) BSI: Brief Symptom Mood Disorder Questionaire: MDQ

11 Patient Health Questionaire: PHQ Purpose: clinically efficient screening tool for mental health disorders. Administration: Self-report < 2 minutes to review Scoring > 5 = further assessment and treatment Follow-up assessment (BSI or SCL 45)

12 Mood Disorder Questionaire: MDQ Purpose: Brief self-report screening for BiPolar Spectrum Disorder N=198 patients Sensitivity:.73 Specificity:.90 Recommendations for use in Primary Care Settings

13 Other Adult Screening Tools Substance Abuse Assessment: AUDIT Intimate Partner Violence: IPV Edinburgh Postpartum Depression Scale

14 Screening for Substance Abuse: AUDIT Primary Care Detection of Alcohol Abuse (WHO) Significant correlations between MAST and CAGE Appropriate for male and female patients High Reliabiltiy (r=.86) 10 Questions: Breadth and Severity Clinical Interview Self-Report Scoring 15-18: Monitoring and Education > 20: Further evaluation and treatment

15 Screening for Abuse: IPV Does the person you love.. Threaten to hurt you or your children? Say it's your fault if he or she hits you, then promises it won't happen again (but it does)? Put you down in public or keep you from contacting family or friends? Throw you down, push, hit, choke, kick, or slap you? Force you to have sex when you don't want to? Scoring: Just one "yes" anwer means you're involved in an abusive relationship.

16 Adolescent Screening Tools Young Adolescent Health Guidelines for Adolescent Preventive Services Middle-Older Teen Younger Teen Parent Form

17 Pediatric Screening Tools Pediatric Symptom Checklist: PSC Vanderbilt ADHD Assessment forms Parent Teacher Autism Screening Tool: M-CHAT

18 Coaching Family Physicians In Mental Health Screening Benefits of early assessment and diagnosis Increase physician awareness of signs and symptoms of mental health disorders Identify appropriate treatments Brief behavioral health interventions Medications Referrals for mental health services Monitor treatment progress.

19 Summary and Discussion Teaching potential of mental health screening tools Specificity and Sensitivity Clinical Interview Skills Risks and limitations of screening instruments Varieties of screening tools