Enhancing eating disorder screening in the outpatient pediatric setting: a quality improvement initiative

Abstract

Screening for eating disorders (EDs) in pediatric patients is crucial for early identification, to allow for timely intervention which could reduce the risk of long-term physical and mental health complications. Pediatric primary care providers are often the first healthcare professionals to address mental health concerns with patients, putting them in a unique position to identify potential EDs early. However, in rural areas like Montana, limited access to specialized care, along with the financial and logistical barriers, present significant challenges in implementing consistent and effective screening programs. Although evidence from governing bodies such as The American Academy of Child and Adolescent Psychiatry supports the implementation of routine screening, eating disorders (EDs) often remain undiagnosed and untreated. Unfortunately, a busy pediatric primary care clinic in Montana was not utilizing a standardized approach for routinely screening for EDs. Using the Model for Improvement, Plan-Do-Study-Act (PDSA) cycles guided the seven-week implementation dedicated to utilizing the SCOFF screening tool at every well-child check and mental health related visit for adolescents aged 12-17, with recommended follow-ups for positive screenings. This project aimed to increase the number of patients screened for EDs. The SCOFF- Based Eating Disorder Screening and Referral Protocol increased the patients screened from 0 to 56, successfully screening 75% of eligible visits over a 7-week period. Barriers to consistency included difficulties in adhering to the new screening protocol and updated workflow practices, compounded by the absence of full clinic participation from all providers. This made it challenging for staff to consistently integrate the new process into their daily routines. The findings support the use of the SCOFF- Based Eating Disorder Screening and Referral Protocol in the pediatric setting for identifying disordered eating. However, future teams may consider integrating an on-site counselor or incorporating Integrated Behavioral Health, along with full participation from all clinic providers, to enhance consistency and further streamline the process for all patients in the clinic. The SCOFF- Based Eating Disorder Screening and Referral Protocol shows immense promise for improving long-term health outcomes for the youth population.