Implementation of a school nurse-led anxiety screening protocol within an elementary school: a quality improvement project

Abstract

Childhood anxiety disorders are becoming increasingly prevalent in the US, with reported cases rising from 7.1% in 2016 to over 9.2% by 2020. This increase is often manifested through somatic symptoms in children, highlighting the urgent need for early detection and intervention, particularly in school settings where these symptoms frequently result in visits to school nurses. In a rural elementary school in Montana, there was a lack of systematic screening for anxiety among students aged 8-12. These students often present with somatic complaints that lack a clear medical diagnosis, leading to under-identification and inconsistent referral practices. The Plan-Do-Study-Act (PDSA) framework guided the implementation of a school nurse-led anxiety screening initiative using the SCARED tool. This project focused on systematic screening of English-speaking students who exhibited recurrent, unexplained somatic symptoms. Key interventions included training the school nurse on the SCARED tool, the establishment of structured screening protocols, and improved communication with parents to meet legislative consent requirements. The initiative was highly successful, achieving a 100% identification rate for students meeting the anxiety criteria, with all positively screened students referred for further support. These results demonstrate a significant enhancement in schools' capacity to manage childhood anxiety. This quality improvement project effectively addressed the rising prevalence of anxiety disorders in elementary students, emphasizing the value of structured, nurse-led screening processes. It successfully met and exceeded the set SMART goals, offering a replicable model for early detection and management of anxiety in schools. This model also highlights the importance of considering somatic complaints as potential indicators of anxiety disorders.