The document discusses the integration of three mental health screening tools - the Psychosocial Screening Tool, PHQ-9, and Mini-Cog - to identify depression and cognitive impairment in HIV patients at a hospital clinic in Dallas, Texas. Statistics show high rates of psychiatric co-morbidity including depression in people living with HIV. The screening tools were piloted and their use was found to identify a significant portion of patients with depression or cognitive issues who could benefit from mental health treatment.

1. The Integration of Three Mental Health
Screening Tools
Cristina Portillo-Via, MSSW, MHA, LCSW
Amy de la Cruz, RN, MEd
Parkland Health & Hospital System
HIV Services
Dallas, TX
Collaborators: Laura Agbiboa, LMSW, Tom Emanuele, BSN, RN-BC, ACRN, & Mental Health PI Workgroup

2. Statistics and Research
Mental Health and HIV
–RAND HCSUS Study:
–2,864 HIV-positive Medical Patients
–Result: Any psychiatric co-morbidity
48%
–Depression is the most common
psychiatric co-morbidity

3. Mental Health Appointments at
Parkland Outpatient Clinic
Type 2007 2008 2009
Outpatient 3,876 4,008 4,337
Medical
Care
Mental 440 497 392
Health
Services
% Mental 11.4 % 12.4% 9.0%
Health
Unduplicated numbers of those who received mental health
service at Parkland, does not include those referred to
outside agencies or no-show appts.

4. Statistics and Research
•Studies have shown relationships
between HIV infection, mood
disorders and adherence and
survival rates.
•Lack of treatment for depression
has shown to increase HIV
replication, non-adherence and
mortality.

5. HOW IT ALL STARTED
2008 - Case Managers piloted the Psychosocial
Screening Tool and PHQ-9 for 3 months.
- Data was collected.
- Case Managers continued to utilize the screening
tools as a part of the intake/update assessment
process.
- 70/189 respondents scored a 10 or above on the
PHQ-9.
-At 6 months, continued to gather follow up data.
2009 -Continued to gather follow up data at 12 months.
- 25.7% of respondents were identified and followed up
with mental health care.
- 24.% of respondents were already receiving mental health care, and
remained complaint during this 12 month period.
- Those who declined mental health services scored a lower score
(10 – 14) on the PHQ-9.

6. PDSA CYCLE

7. SWOT Analysis

8. Psychosocial Screening Tool

9. PHQ-9

10. PHQ – 9 scoring and intervention:
0–4 No intervention recommended
5–9 Discuss with patient offer therapy
10 – 14 Discuss medication and/or therapy. Give results to
PCP to write and manage antidepressant medication if
patient desires.
15 – 19 Discuss medication and/or therapy. Give results to
PCP for antidepressant medication and next available
appointment with psychiatrist.
>20 Discuss medication and/or therapy. Appointment with
psychiatrist within 1 week.

11. Mini-Cog

12. Case Scenarios