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Project Title:

Implementing assessment tool which measures depression, anxiety and stress in a Outpatient Mental health Private Practice

Doctorate Student Name:

Ramona Wilkerson

Check One:

X 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:

Hudson Regional Hospital

Faculty Information:

Faculty Name: Colleen Bartlett

Faculty Email:[email protected]

Faculty Phone:

352-428-7472

Anticipated Start Date:

2-1-24

Anticipated Completion Date:

5-1-24

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 8 weeks, this project will help to fill the gap which currently exists in the assessment of stress in outpatients in our clinic. Through administering the Depression, Anxiety, and Stress Scale (DASS21), we aim at conducting a more organized approach to evaluating stress prevalence in our patients (Ali, et al., 2022). Therefore, the aim will be to revolutionize patient care and satisfaction in routine practice through stress assessment, which, in turn, will enable proffering of appropriate psychotherapy stress remedies to patients. By week eight from the initiation of the project, we intend to review the patient outcomes as well as satisfaction rate and compare it with the initial parameters to note the impact of improvement. The direct target recipients of this improvement effort are the patient with mental illness that seek outpatient services from our practice. This project includes all facets of the stress assessment process, from incorporating stress assessment in to overall patient assessment, to providing adequate psychotherapy to stressed out patients, and ensuring the best quality of care for our patient panels (Halford, & Frost, 2021).

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.

Overview of the problem

Stress as a concept is widely discussed and known to be the major factor affecting mental health globally. They are detrimental to the individual’s overall well-being and can lead to certain mental disorders like depression and anxiety disorders (WHO, 2022). Chronic stress worsens a patient’s symptoms in case of having some diagnosed psychiatric disorder, and acute stress may result in the creation of a new disorder if not addressed (American Psychiatry Association [APA], 2022).

Local Problem in Practice

Stress is an issue that is often present in the lives of many of the patients in our outpatient mental clinic, an independent Psychiatric practice. It has been seen that the patients used to complain and the doctors and other health care professionals who attended them also noticed that the various patients seemed highly stressed and anxious. Based on patient input records kept at the internal clinic, it is established that about 60% of patients show their stress levels ranging from moderate to severe during clinical evaluation and they have higher chances of being diagnosed with depression or anxiety disorders (Smith, 2023).

Purpose of the Project

The aim of this project is to pilot the use of the Depression, Anxiety, and Stress Scale (DASS21) and manage patient stress in a private practice outpatient mental health clinic. 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.

Proposed Strategy

· Implementation of DASS21: Implement the DASS21 tool for the initial patient assessment and subsequent follow-up to quantify stress, anxiety, and depression scores.

· Training Staff: Trials and methods: Educate healthcare providers in the practice using the DASS21 in the administration and comprehension of results.

· Integration into Routine Care: Extend the use of DASS21 assessment to incorporate it into standard patient evaluations by using it at various patient encounters.

· Data Collection and Analysis: Quantitative patient data related to stress should be gathered before and after the use of DASS21. Age and other characteristics of the patients should also be described and compared between the two groups to determine if the intervention improved the outcomes of the patients.

Evaluative Measures

Pre- and Post-Implementation Stress Levels: Analyze the stress patient’s self-assessment using the scale before and after the application of the DASS21 tool.

Patient Satisfaction: Patient satisfaction can also be assessed through using surveys and feedback forms with the DASS21 patient’s tool (Beaufort, et al., 2017).

Clinical Outcomes: This will look at the degree of clinical improvement compared to baseline using medical documentation of patients’ status and follow-up surveys where the patients’ levels of depression and anxiety have presumably dropped.

Desired Outcomes

· Reduction in Stress Levels: Reduce the inhabitants’ reported tension points for patients to a very low level.

· Improved Mental Health: Improve general concern regarding possible depression and anxiety from stress management.

· Increased Patient Satisfaction: Improve the number of patients who are satisfied with the mental health services delivered by the organization.

· Enhanced Clinical Practice: Enhance patient care by adopting a validated instrument for stress evaluation as well as monitoring the effectiveness of clinical interventions for handling stress.

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

.

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 development of the suggested quality improvement plan is targeting the optimization of, and increasing patient satisfaction in an outpatient mental health private practice through the implementation of stress assessment via Depression, Anxiety, and Stress Scale 21. This is a comprehensive stress assessment project where the aim is to screen patient populations for specific stress levels and where respective psychotherapeutic stress reduction approaches will be used to minimize stress and enhance quality of life. In addressing this plan, an important approach is to incorporate the DASS21 scale into the basic assessment of patients as well as their follow-up visits to guarantee a systematic assessment of patients’ stress levels (D’Amico, et al., 2024). The shifts in the patient outcomes to be employed in the proposed project pertain to patients’ perceived stress levels, depression, and anxiety levels before and after the implementation of the stress assessment tool, in addition to patients’ satisfaction with the use of the stress assessment tool. The expected impact is expected to be the increased percentage of patients who will be relieved from stress, continued emotional well-being, and overall satisfaction with outpatient mental health services offered at the organization.

Institutional Review Board (IRB) Application for Quality Improvement or Innovation Project Approval

Sources

Halford, W. K., & Frost, A. D. (2021). Depression anxiety stress scale-10: A brief measure for routine psychotherapy outcome and progress assessment.  Behaviour 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

D’Amico, F., Navarrete, J., Montero-Marín, J., Cardeñosa-Valera, E., Navarro-Gil, M., Pérez-Aranda, A., ... & Luciano, J. V. (2024). Cost-utility of attachment-based compassion therapy (ABCT) and mindfulness-based stress reduction (MBSR) in the management of depressive, anxious, and adjustment disorders in mental health settings: Economic evaluation alongside a randomized controlled trial.  Mindfulness,  15(3), 559-569. https://link.springer.com/article/10.1007/s12671-024-02319-4

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.

Regarding data protection, the necessary precautions shall be observed relating to paper documents that contain protected or identifying personal information as well as electronic records. Paper-based records will be secured in a locked cabinet or file, and digital records will be saved in password-protected computers only those persons have access who are concerned with it. This system will not be open to the public; access to all the departments will be allowed based on the access code and privileges granted to users. Secured updates or patches will be offered after each period to help in the protection of the system. Any accompanying physical documents will be secured in locked cabinets in an office only to be accessed by authorized personnel. Use of these cabinets will be limited and the keys shall be kept safely under lock and key by the authorized personnel.

As for the data retention period, the company will meet legal and industry standards concerning the data retention period with a concrete retention period defined in the data retention policy. The last point entails data disposal where the data is no longer useful or has aged out of the retention period set for it; it shall be deleted using standard methods of data disposal. Hard copy documents will be expelled using a cross-cut shredder for the destruction of any sensitive information. Digital data will be erased from the program by employing careful measures such as digital shredding and overwriting.

Additional daily, weekly, monthly, and annual checks are proposed to perform verification of the adherence to the data security requirements and to investigate possible threats. Specific personnel in each center will be tasked with conducting these audits from time to time and any issues arising out of this process will be addressed to minimize risks to the integrity of data. Finally, training in data security measures and guidelines will be provided to all employees to guard against violations of rules as well as to reduce cases of data leakage or instances in which unauthorized individuals gain access to such data.