Team-Effectiveness Barriers and Solutions to Depression Screening within a Pediatric Hospital Network: A Qualitative Study.

Background: An increasing number of hospital systems have implemented universal depression screening protocols in response to the growing prevalence of pediatric depression. However, to date no studies have qualitatively explored how the sustainment of depression screening workflow functions in practice. Objective: To characterize the workflow for an existing universal depression screening pathway within a large pediatric healthcare system and explore barriers and solutions to barriers in implementing the workflow effectively. Method: Eight focus groups with 37 staff members in a large pediatric hospital system were conducted. Participants were considered eligible if they were involved in depression screening within their unit. Focus groups were recorded, transcribed, and analyzed for themes using rapid qualitative analysis. Results: Six barriers and five proposed solutions were identified as common themes across units, organized along three stages of the depression care cascade: screening, assessment and resources, and disposition planning. Key barriers included the language appropriateness of the Patient Health Questionnaire-9 (PHQ-9) for younger and neurodivergent patients, siloing of medical and behavioral health roles, and lack of infrastructure for follow-up after referral. Proposed solutions included adapting screening language, cross-training staff in mental health assessment, and designating dedicated roles for follow-up. Conclusions: Our findings suggest that strategies aimed at improving how teams work together could assist hospitals in delivering depression screening at all stages through better team coordination and role clarification.