270 - The Feeling Flower: A Pediatric Mental Health Screening Tool

Publication Number: 3259.270

Saira Abbasi, Kaiser Permanente Pediatric Care Center, Fullerton, CA, United States; Annie Tran. Carr, Kaiser Permanente Pediatric Care Center, Anaheim, CA, United States; Beverly Lallande, Southern California Permanente Medical Group, Santa Ana, CA, United States

Background: Pediatric mental illness leads to difficulties in daily functioning at home, in school and in social settings, which may thus pose risk for substance use, safety, or suicide. The U.S. Preventive Services Task Force (USPSTF) recommends screening children 12 yrs and older for depression with the validated screening tool Patient Health Questionnaire (PHQ-9). USPSTF has identified further trials are needed to evaluate best methods to screen children under 11years old. Moreover, a self-reported tool in this age group presents as a challenge as young children may not be able to verbally articulate complex emotions. Art emerges as a universal language that can surpass these verbal limitations, providing an alternative means of expressing thought, emotion and communication.

Objective: Implement a self-reported, art based, mental health screening tool for patients ages 5-11 years in various pediatric clinics and determine feasibility to screen for early signs of mental health conditions.

Design/Methods: The Feeling Flower Screening Tool (FFST) (Diagram 1) allows the pediatric patient to self-report their emotions and feelings towards 8 various aspects of life defined by a color. Each color and feeling reported is numerically scored and tabulated (Table 1), providing a quantitative measure to help clinicians determine need for further psychosocial support or intervention. A patient with a total score of 1 or more, defined as an actionable and significant score, would benefit from further clinical assessment. After parental consent is obtained, the FFST and coloring tools are given to pediatric patients to complete accompanied by parent and the colored FFST is reviewed by the provider. FFST was administered in a General Pediatric and Pediatric Subspecialty Clinic to capture a wide variety of pediatric patients.

Results: All 54 pediatric patients aged 5-11years were screened successfully, of which 23 were being seen for a well visit and 31 were being seen for chronic illness visit (Table 1). 1 of 23 pediatric well visit patients and 13 of 31 chronically ill patients were screened as having actionable and significant feelings with a score of 1 or higher (Graph 1).

Conclusion(s): This pilot study demonstrates the FFST can be used to screen for mental health conditions in pediatric patients by way of artistic expression. As the PHQ-9 is a standardized screening tool which is clinically validated for children greater than 12 years of age, the FFST may be considered as an accepted standard of care tool in children aged 5-11 years, as there is currently not a clinical screening tool available for this age group.

Diagram 1: Feeling Flower Mental Health Screening Tool
Tool utilized to screen the young pediatric patient for mental health illness.

Table 1: Feeling Flower Screening Tool Table of Scores and Self Reported Screening Scoring System
Feeling Flower Table 1.pdfBased on how the pediatric patient colors each petal on the FFST, representing their feelings towards various aspects of life, a score is assigned and then tabulated for each patient as seen in Table 1. As the scoring system indicates, a score of 1 or higher may indicate need for further evaluation by the pediatric provider.

Graph 1: Feeling Flower Screening Tool Results
Feeling Flower Graph.pdfGraphed results of FFST scores indicate this tool is able to identify the pediatric patient's distinct feelings and emotions towards various aspects in life, which may thus be actionable by their provider and require further evaluation. Of note, the FFST tool identifies more patients with actionable scores in the chronically ill pediatric patient population.