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Training and Administration of Behavioral Health Screens Within the Veterans Health Administration

Funderburk Jennifer S, Crasta Dev, Maisto Stephen A

Background: When incorporating behavioral health screens into routine practice, it is important to develop implementation and quality monitoring plans that will maximize the sensitivity and specificity of the screening measures improving quality of the clinical information and reducing errors. Each Veteran’s Health Administration (VHA) primary care clinic has implemented annual screening for depression and hazardous alcohol use for several years, and their experience can help guide primary care clinics in the private sector as they implement behavioral health screens.

Aim: Describe VHA primary care local procedures for the implementation of annual screenings for depression and hazardous alcohol use.

Methods: Cross-sectional online survey. Primary care staff from more than 900 VHA primary care clinics within all 21 VHA regional networks across the United States was eligible to participate. Primary care listservs were used to identify a random sample of 3,932 primary care staff, which was then stratified to ensure that all 21 regional networks were represented. There were no exclusion criteria. The final sample of 1120 participants (29% response rate) completed the survey.

Main Measures: Descriptive online survey.

Results: Respondents indicated that the AUDIT-C is primarily administered verbally by nurses in the exam room. A large majority of the respondents reported that the PHQ- 2 is also typically administered by nurses using the same method (i.e., administration style, location and timing) as that for the AUDIT-C. Fewer than half of the respondents who regularly administer screens endorsed being trained in the AUDIT-C (41.1%) and PHQ-2 (49.0%). Among those trained in administering the AUDIT-C, fewer than half reported that their training included discussions of best practices for administration procedures.

Conclusion: These findings highlight important training gaps regarding the process of screening within a primary care practice. Best practices in administration of health screens are commonly neglected, despite being essential to screening measures having strong psychometric properties.