Monitoring patient progress and changes in patient and clinician reported symptoms with measurement informed care in a pediatric primary care mental health integration program.
- 1Transforming Mental Health, Rady Children's Hospital - San Diego, San Diego, CA, United States.
- 2Department of Psychiatry, Child and Adolescent Division, University of California San Diego, San Diego, CA, United States.
- 3Department of Pediatrics, University of California San Diego, San Diego, CA, United States.
Abstract
Measurement informed care (MIC) utilizes validated instruments to screen and monitor patient symptoms and has been shown to improve patient outcomes and streamline diagnostic processes. Our primary care mental health integration (PCMHI) program embedded mental health clinicians in the pediatric primary care setting to increase access to mental healthcare and provide care for adolescents. The purpose of this study was to identify changes in patients' self-reported symptom severity and determine whether provider assessments of patient progress were associated with patients' completed screening scores between the initial and final visits of short-term treatment within a PCMHI program. Patients were retrospective from a multisite pediatric PCMHI program. The program's standardized measures included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for patients older than 12 years and the Pediatric Symptom Checklist-17 (PSC-17) for patients younger than 12 years. Before each PCMHI session, patients completed self-reported assessments, and after the session, clinicians provided a score reflecting overall patient progress. Data from treated patients were extracted from electronic medical records, and changes in patient scores were calculated and analyzed using Stata 16.1 (College Station, TX). A total of 2,702 patients were eligible for analysis. Significant reductions (95% CIs) in the proportion of patients scoring above clinically relevant cutoffs were observed for the PHQ-9 (28.8%; 26.1-31.5%), GAD-7 (25.8%; 23.4-28.4%), PSC-17 attention subscale (16.5%; 14.6-18.6%), and PSC-17 internalizing subscale (17.3%; 15.3-19.4%) (all p < 0.001). No significant change was identified for the PSC-17 externalizing subscale (11.0%; 9.4-12.8%; p = 0.19). Effect sizes for score change among patients above the clinical cutoff were large (r = 0.68-0.80 across the PHQ-9 and GAD-7 severity scores), and the odds of moving below the cutoff exceeded the odds of moving above it for every measure except the externalizing subscale. CGI improvement scores were significantly correlated with the PHQ-9, GAD-7, and each of the PSC-17 subscales (all p < 0.001). Validated mental health assessments, completed by patients before their appointments, documented reductions in symptom severity over brief, short-term treatment and changes in patient- and clinician-completed assessments were significantly correlated. These results demonstrate the feasibility of using patient-provided self-assessments to monitor patient progress.
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BibTeX
@article{adams2026monitoring,
title = {{Monitoring patient progress and changes in patient and clinician reported symptoms with measurement informed care in a pediatric primary care mental health integration program.}},
author = {Devin P Adams and Jason Schweitzer and Jasmine R Holt and Anne F Bird and Nicole Carr-Lee and Kathryn A Hollenbach},
journal = {Frontiers in psychology},
year = {2026},
month = oct,
doi = {10.3389/fpsyg.2026.1898860},
url = {https://europepmc.org/article/MED/42952758},
note = {CC BY},
}
RIS
TY - JOUR
TI - Monitoring patient progress and changes in patient and clinician reported symptoms with measurement informed care in a pediatric primary care mental health integration program.
AU - Devin P Adams
AU - Jason Schweitzer
AU - Jasmine R Holt
AU - Anne F Bird
AU - Nicole Carr-Lee
AU - Kathryn A Hollenbach
PY - 2026
DA - 2026/10/14
JO - Frontiers in psychology
DO - 10.3389/fpsyg.2026.1898860
UR - https://europepmc.org/article/MED/42952758
AB - Measurement informed care (MIC) utilizes validated instruments to screen and monitor patient symptoms and has been shown to improve patient outcomes and streamline diagnostic processes. Our primary care mental health integration (PCMHI) program embedded mental health clinicians in the pediatric primary care setting to increase access to mental healthcare and provide care for adolescents. The purpose of this study was to identify changes in patients' self-reported symptom severity and determine whether provider assessments of patient progress were associated with patients' completed screening scores between the initial and final visits of short-term treatment within a PCMHI program. Patients were retrospective from a multisite pediatric PCMHI program. The program's standardized measures included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for patients older than 12 years and the Pediatric Symptom Checklist-17 (PSC-17) for patients younger than 12 years. Before each PCMHI session, patients completed self-reported assessments, and after the session, clinicians provided a score reflecting overall patient progress. Data from treated patients were extracted from electronic medical records, and changes in patient scores were calculated and analyzed using Stata 16.1 (College Station, TX). A total of 2,702 patients were eligible for analysis. Significant reductions (95% CIs) in the proportion of patients scoring above clinically relevant cutoffs were observed for the PHQ-9 (28.8%; 26.1-31.5%), GAD-7 (25.8%; 23.4-28.4%), PSC-17 attention subscale (16.5%; 14.6-18.6%), and PSC-17 internalizing subscale (17.3%; 15.3-19.4%) (all p < 0.001). No significant change was identified for the PSC-17 externalizing subscale (11.0%; 9.4-12.8%; p = 0.19). Effect sizes for score change among patients above the clinical cutoff were large (r = 0.68-0.80 across the PHQ-9 and GAD-7 severity scores), and the odds of moving below the cutoff exceeded the odds of moving above it for every measure except the externalizing subscale. CGI improvement scores were significantly correlated with the PHQ-9, GAD-7, and each of the PSC-17 subscales (all p < 0.001). Validated mental health assessments, completed by patients before their appointments, documented reductions in symptom severity over brief, short-term treatment and changes in patient- and clinician-completed assessments were significantly correlated. These results demonstrate the feasibility of using patient-provided self-assessments to monitor patient progress.
SN - 1664-1078
ER -