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Project Title:

Implementing an evidenced based scale that measures depression, anxiety and stress in an outpatient mental health private practice.

Doctorate Student Name:

Ramona Wilkerson

Check One:

· Herzing University Student

· Student not affiliated with Herzing University – list institution this project is affiliated with: __________________________________

Email:

[email protected]

Primary Phone Number:

201-706-1511

Location/Sponsor:

Wilkerson & Company LLC- Danielle Weitzer

Faculty Information:

Faculty Name: Colleen Bartlett

Faculty Email: [email protected]

Faculty Phone: 352-428-7472

Anticipated Start Date:

6–17-24

Anticipated Completion

Date:

8-17-24

Aim Statement

Key elements of the aim statement needed to be included:

1. What? What’s the problem or opportunity? 2. How much? By how much will you improve? Or “how good” do you want to get? 3. By when? What is the date by which you will achieve the level of improvement you’ve set out to accomplish? 4. For whom? Who is the customer or population who will benefit from the improvement? 5. Where? What are the boundaries of the process or system you’re trying to improve? Where does it begin and end?

Over the course of 12 weeks, an evidence-based screening tool - the Depression, Anxiety, and Stress Scale (DASS21) will be implemented in the project practice setting aimed at identifying patients for whom psychotherapy stress remedies are appropriate for inclusion

in the patient’s treatment plan. The implementation of the DASS21 is expected to identify patients with worsening depression, anxiety, and stress, facilitating timely psychotherapy remedies. This should lead to reduced levels of depression, anxiety, and stress, improved mental health, and increased patient satisfaction.

https://www2.psy.unsw.edu.au/groups/dass/DASSFAQ.htm

Project Overview

Please provide a summary of the proposed quality improvement or innovation project including the purpose, proposed strategy to be utilized, proposed project measures that will be utilized to evaluate outcomes, and the anticipated/desired outcomes.

You need a statement like on your last application that addresses the problem as to why you are doing your project with a reference. You should have a global statement and local if available. You used stress and statistics from WHO. You can use mental health disorder statistics from the stame website if you would like. Dr. Penick did not ask that you delete that.

Stress as a concept is widely discussed and known to be the major factor affecting mental health globally (WHO, 2019). Stress is detrimental to the individual’s overall well-being and can lead to certain mental disorders like depression and anxiety disorders (WHO, 2022). Chronic stress can worsen symptoms in patients that are diagnosed with psychiatric disorders. (American Psychiatry Association [APA], 2022). ( This was your statement I would leave it here)You could add something about depression and anxiety to this already formulated paragraph.

These research endeavors to implement the Depression, Anxiety, and Stress Scale (DASS21) in an outpatient mental health facility (). The aims are to determine the prevalence rates of depression, anxiety, and stress among patients and subsequently offer appropriate psychotherapy interventions. The project aims at enhancing patient outcomes associated with mental health issues by identifying and responding to symptoms linked to depression, anxiety, and stress (WHO, 2022). These conditions can worsen symptoms in patients that are diagnosed with psychiatric disorders. (American Psychiatry Association [APA], 2022). Research has shown that the questions outlined in the DASS21 are effective in identifying depression, anxiety, and stress in patients (Smith, 2023).

As a provider in an outpatient psychiatric clinic, it has been noted that stress is a common theme with patients. Research has shown that patients that have stress ranging from moderate to severe have higher chances of being diagnosed with depression or anxiety disorders (Smith, 2023).

Research has shown that the questions outlined in the DASS21 are effective in identifying depression, anxiety, and stress in patients (Smith, 2023). You were not to remove this per the last markup.

The purpose of this project is to implement the use of the Depression, Anxiety, and Stress Scale (DASS21) in an established private mental health practice aimed at evaluating stress prevalence and offering psychotherapy stress remedies to improve patient outcomes related to their mental health diagnoses. When implemented into practice, the project involves the identification and management of stress-illness, with the intention of optimizing the patient’s overall health outcomes about their mental health diagnoses.

Process measures will be utilized to evaluate the project outcomes.

The first process includes evaluating the percentage of patients identified for whom the DASS21 scale was implemented during their visit to the outpatient clinic.

The second process measure will evaluate the percentage of patients that received psychotherapeutic interventions for stress management compared to the percentage of patients for whom DASS21 demonstrated psychotherapeutic interventions for stress management was appropriate.

Process evaluations will also include a narrative discussion of the feedback provided by the DNP student and medical director about the implementation of DASS21. The discussion will include the level of satisfaction and workflow related to the administration of the tool.

The last outcome measure will be to re-evaluate patients’ depression, anxiety, and stress levels using the DASS21 at their 4 week follow up appointments. (Beaufort, et al., 2017). The primary interest is solely in evaluating stress and thus it is possible to administer only the stress scale questions from the DASS21. This approach focuses specifically on the stress-related symptoms and can streamline the assessment process. I am confused by this statement? I thought you had decided to do all 21 items, so this should be removed as you are not only doing stress correct?

The predicted outcome is that the implementation of DASS21 will identify patients with worsening depression, anxiety, and stress to provide them with timely psychotherapy. The 21-item Depression Anxiety Stress Scale (DASS) should first be utilized for the purpose of

obtaining baseline values of depression, anxiety, and stress. While three items for each condition are required in order to capture changes, the completion of the entire DASS affords a complete baseline. It is also recommended that after the patient has commenced psychotherapy, they complete the DASS again in order to determine the amount of change in reported symptoms from baseline. Presenting the actual pre-therapy and post-therapy DASS scores in tabular format to the reader also offers a clear view of how helpful the therapy was and how the patient benefited from it. As opposed to solely using specific sections, occasionally using the whole DASS provides information about how the patient’s condition changes in the process of treatment. 8 weeks are not sufficient to effectively diagnose and treat the problems that the patient is experiencing. Thus, in line with previous research, this intervention period of 12 weeks allows for enough time to comprehensively assess symptoms using the DASS and offer sufficient psychotherapy (Yong, et al., 2022).

References

World Health Organization. (2022). World mental health report: Transforming mental health for all.

American Psychological Association. (2022). Stress in America. https://archive.hshsl.umaryland.edu/handle/10713/20295

Beaufort, I. N., De Weert-Van Oene, G. H., Buwalda, V. A., De Leeuw, J. R. J., & Goudriaan, A. E. (2017). The depression, anxiety and stress scale (DASS-21) as a screener for depression in substance use disorder inpatients: a pilot study.  European addiction research,  23(5), 260-268. https://karger.com/ear/article/23/5/260/119698/The-Depression-Anxiety-and-Stress-Scale-DASS-21-as

Halford, W. K., & Frost, A. D. (2021). Depression anxiety stress scale-10: A brief measure for routine psychotherapy outcome and progress assessment.  Behavior Change,  38(4), 221-234. https://www.cambridge.org/core/journals/behaviour-change/article/abs/depression-anxiety-stress-scale10-a-brief-measure-for-routine-psychotherapy-outcome-and-progress-assessment/2259B3A2EB360EE3BD007AAFCD73ED70

Ali, A. M., Hori, H., Kim, Y., & Kunugi, H. (2022). The Depression Anxiety Stress Scale 8-items expresses robust psychometric properties as an ideal shorter version of the Depression Anxiety Stress Scale 21 among healthy respondents from three continents.  Frontiers in psychology,  13, 799769. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.799769/full

World Health Organization. (2019). Mental health: Strengthening our response. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Smith, J. (2023). The impact of stress on clinical evaluations and diagnoses of depression and anxiety disorders. Journal of Mental Health Studies, 45(3), 210-223.

Park, S. H., Song, Y. J. C., Demetriou, E. A., Pepper, K. L., Thomas, E. E., Hickie, I. B., & Guastella, A. J. (2020). Validation of the 21-item Depression, Anxiety, and Stress Scales (DASS-21) in individuals with autism spectrum disorder.  Psychiatry Research,  291, 113300. https://www.sciencedirect.com/science/article/abs/pii/S0165178120302973

Yong, X. Y., Sui, C. F., Liew, M. Y., Chong, T. W. S., & Liew, J. Y. (2022). Psychological distress screening for depression, anxiety and stress among medical ward patients in hospital Tapah, Malaysia: a cross-sectional study using the Depression, Anxiety and Stress Scale (DASS-21).  Journal of Health Science and Medical Research. http://myscholar.umk.edu.my/handle/123456789/3291

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QI Framework

Please provide an overview of the framework that will be utilized in the proposed project (e.g. KTA, PDSA, ADKAR, Lean, Six Sigma, DMAIC, etc.).

The PDSA framework will be used for this project.

The project will be conducted over 12 weeks.

The DNP student will serve as the implementation leader. The only other team member will be the medical director of the practice.

The focus is on all patients who present with a mental health diagnosis and range in age from 18-65.

The predicted outcome is that the implementation of DASS21 will identify patients with worsening depression, anxiety, and stress to provide them with timely psychotherapy stress remedies. This will support a reduction in stress levels, improved mental health, and increased patient satisfaction. As previously indicated, two process measures and a narrative overview will be utilized to evaluate the projects’ outcome of individualized psychotherapy stress remedies with the data from the DASS21.

The completed DASS21 will be collected by the DNP student and reviewed to determine individualized care plans. Permission to utilize DASS21 is not required as it is a public domain. Copies of the tool will be printed and readily available for use with patients that come in for their mental health appointments.

Data Security

Please provide a description of your data security plan for both physical and electronic data that includes protected or identifying personal information. Include where the data will be stored, the security of the location or computer system, the length of retention of the data, and the method of disposition of old data.

The list of patients that are seen by the DNP student will be kept in the students locked protected file on hard drive.

The data collected as part of the project will not include any protected or identified personal information.

The DNP student has developed a checklist to monitor and record the number of patients for whom DASS21 was implemented.

Additionally, the DNP student has developed a tracking sheet to determine the number of patients for whom the DASS21 Indicated a need for psychotherapy stress remedies and the number in which this was appropriately executed.

https://maic.qld.gov.au/wp-content/uploads/2016/07/DASS-21.pdf