Implementation of a Mental Health Screening Tool at an Adult Homeless Shelter Student-Run Free Clinic in Arizona
Abstract
Background: Mental health conditions are prevalent in people experiencing homelessness. This population may seek care in student-run free clinics (SRFCs), but screening for mental health conditions may not be consistent in this setting. The primary objective of our study was to implement a screening tool and determine the gap in identifying mental health conditions between History and Physical (H&P) examinations and the new screening tool. Secondary objectives were to assess its impact on patient volume and workflow.
Methods: Adult patients at a homeless shelter-based SRFC completed a mental health screening survey, separate from acute-care visits, aimed at identifying “high-risk†mental health conditions using validated questionnaires for identifying domestic violence, alcohol use, depression, anxiety, and mood disorders. Chart review was conducted to identify concordance between patients who screened positive for a high-risk condition using the survey and those with a high-risk condition documented in the acute-care H&P. Visit volume was tabulated and compared between the pre- and post-intervention periods using a t-test. A survey for volunteers was used to gather experiential feedback.
Results: Of 354 patients treated at Central Arizona Shelter Services, 123 (34.7%) were evaluated by the research team. Sixty (48.8%) of screened patients were identified as high-risk for at least one mental health condition through the screening tool, and 26 (43.3%) charts were reviewed. Of the patients that were screened as high-risk and reviewed, 15 (57.7%) were not documented as high-risk in the acute-care visit H&P. The clinic volume averaged 11 patients, regardless of whether screening occurred during clinic (p = 0.95). Of clinic volunteers, 191 (97.4%) reported no noticeable impact on clinic operations.
Conclusions: The screening survey identified more cases of mental health conditions than the previous standard medical interview. There were no adverse effects on the clinic workflow.
Copyright (c) 2021 Megan Flores, Kelsey Kairis, Steven Ater, Amy Stein, George Chen, Michelle Mifflin
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