198 - Silent Struggles: Enhancing Depression Detection and Response in Child Advocacy Centers

Publication Number: 3190.198

Kendra K. Ham, Atrium Health Levine Children's Hospital, Charlotte, NC, United States; Melissa A. Martin, Levine Children's Hospital, Salisbury, NC, United States; Tamara G. Napier, Levine Children's Hospital, Oakboro, NC, United States; Talia Buitrago-Mogollon, Levine Children's Hospital, Charlotte, NC, United States

Background: The child advocacy centers (CACs) at our institution have seen more patients presenting with depression and suicidal ideation since the COVID-19 pandemic. Literature supports this, citing suicide as the 2nd most common death in adolescents. Patients evaluated in CACs often have multiple ACEs and risk factors. There is no national standard for depression screening at CACs.

Objective: We aimed to minimize the impact of depression in 12- to 17-year-old patients in 4 CACs by standardizing PHQ-9 screening and ensuring all positive scores have appropriate intervention.

Design/Methods: The Model for Improvement and rapid Plan-Do-Study-Act cycles were the framework. At baseline, no standardized depression screenings were done during CAC medical evaluations. Clinical teammates completed a readiness checklist to assess preparedness to implement screenings as part of a routine visit. An interdisciplinary workgroup developed crisis protocols for actively suicidal patients, an emergency mental health resource list, a workflow to complete screening, scoring, data entry into the EHR, and documentation of interventions. An Epic dot phrase was embedded in the note template for PHQ-9 score and intervention documentation. The workgroup met monthly to review data and identify issues.

Results: A total of 296 patients were screened across 4 CACs 1/2024-9/2025. Performance of screen completion increased from 0 to median of 90% and sustained at or above 90% for 11 months over the project's last year 10/2024-9/2025. 95% of the 100 positive screens received interventions/resources based on acuity. The performance of response to positive screens improved from 33% to 100%, sustained at 100% since 8/2024. The median for positive screens was 61%, ranging 48%-100%.

Conclusion(s): Depression screening improved to 90% and over half of patients who completed the PHQ-9 depression screen had positive scores. This work revealed that additional risk factors were identified outside of patients' ACEs. Data highlights project impact with 95% of positive screens receiving appropriate interventions/resources based on specific scores and acuity levels, confirming that implementing routine depression screenings at CACs could significantly reduce the risk of negative outcomes associated with depression and minimize risk of suicidality.

1. National Center for Biotechnology Information. (n.d.). Bookshelf. A service of the National Library of Medicine.
2. Screening for & Responding to Suicidality Among Youth Presenting to a Children's Advocacy Center (CAC). (2023). J. Child & Adolesc. Trauma.

CAC Patients Screened for Depression
Graph shows the number of CAC patients that were screened for depression from January 2024 to September 2025.

Positive Screens
Graph shows the number of positive depression screens from January 2024 to September 2025.

Positive Screens with Response Documented
Graph shows the number of positive depression screens with documented response and intervention.