Anxiety and Depression Change Package Key Drivers and Interventions

The Anxiety and Depression ECHO project aimed to improve screening, assessment, and follow-up procedures for behavioral and mental health care, specifically around anxiety and depression. The project focused on care for patients aged 8–21 years and used quality improvement methodology to support measurable, practice-level changes.

Key drivers are broad, evidence-based and best-practice actions that can be useful in the development of more specific ideas for changes that lead to improvement and are paired with interventions.

Interventions are specific ideas for changing a process; they can be rapidly tested on a small scale to determine whether they result in improvements in a particular context or environment. To support making changes, evidence or practice-based tools and resources were paired with the intervention(s).

1. Utilization of validated mental health screening tools

Interventions

Assess current process flow map for screening by identifying roles and responsibilities of care team, identifying gaps and opportunities for improvement.
Design practice specific screening process with validated tools.
Train staff and providers on how to use validated screening tools.
Develop pre-visit workflow to screen prior to scheduled health supervision visits.
Develop a process for patients not pre-screened
Incorporate patient and parent/caregiver feedback into screening processes.

Resources

2. Development of reliable processes and protocols for management of positive screens

Interventions

Identify provider education resources to increase knowledge and confidence.
Implement standardization of response to positive screens.
Develop a crisis management plan with a stepped protocol for positive screens.
Implement warm handoffs to behavioral therapy providers or to a collocated or integrated mental health professional.
Standardize medication management protocols of patients with diagnosed anxiety and depression.

Resources

3. Facilitation of successful referrals

Interventions

Identify and establish relationships with community-based organizations (schools, faith-based, sports).
Develop a network of care providers for referral and management.
Develop and standardize follow-up processes, such as a recall system.
Develop process for rescreening positive screens.
Establish monthly reports in clinic workflow for positive screens, to monitor referral tracking and follow up.

Resources

4. Utilization of data and population health strategies to manage patients

Interventions

Use data collection/EMR reports to monitor practice-wide improvements, implementation and sustainability.
Create written documentation of workflows, protocols and job descriptions.
Assign roles and responsibilities for staff/clinicians to manage patients with positive screens for depression, anxiety and suicide risk.
Consider using population management tools to evaluate the care of patients not seen for health supervision visits or no shows.

Resources

No exemplary resources available due to the practice specificity needed.

5. Enhancement of skills for effective utilization of Brief Interventions

Interventions

Identify and share Brief Intervention tools and resources.
Conduct training sessions involving simulation of conversations with patients and parents/caregivers focused on mental health concerns.

Resources

6. Engagement of patients and families to identify strengths

Interventions

Develop various strategies to help patients and families identify their own strengths.
Develop script for asking patients and families about their strengths.

Resources

Eliciting Youth and Parental Strengths and Needs (Bright Futures Implementation Tip Sheet)
Identifying Family Strengths and Addressing Health-Related Social Needs (Center for Health Care Strategies)
Mental Health Resources for Families (including anxiety and depression)
Facts for Families – Suicide Safety: Precautions at Home (American Academy of Child and Adolescent Psychiatry)
Facts for Families – Suicide in Children and Teens (American Academy of Child and Adolescent Psychiatry)

Anxiety and Depression ECHO Project Podcasts

Start with Trust: Shared Decision Making in Children’s Mental Health

Shared decision making is more than offering choices — it’s about trust, partnership, and seeing families as the experts of their own lives. In this heartfelt conversation, 2 caregivers share what it looks like when care feels supportive. Their stories highlight how trauma exposure, communication, and respect shape every moment of care.

Shared decision making podcast platform links: Amazon, Apple, Spotify, YouTube

Small Changes, Big Impact: Reimagining Mental Health in Pediatric Primary Care

Youth mental health concerns are rising—and primary care providers are often the first line of support. In this episode, we explore how small, meaningful changes in everyday practice can make a real difference. Two pediatricians share how they introduced strengths-based conversations, collaborative safety plans, and practical mental health supports in their pediatric practices without overwhelming workflows or adding hours to the day.

Small Changes, Big Impact podcast platform links: Amazon. Apple, Spotify, YouTube

Anxiety and Depression Change Package Key Drivers and Interventions

Interventions

Resources

Interventions

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Interventions

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Interventions

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Interventions

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Interventions

Resources

Anxiety and Depression ECHO Project Podcasts

Start with Trust: Shared Decision Making in Children’s Mental Health

Small Changes, Big Impact: Reimagining Mental Health in Pediatric Primary Care

AAP Programs and Resources

AAP Mental Health Initiatives

Bright Futures National Center

Blueprint for Youth Suicide Prevention

National Center for Relational Health and Trauma-Informed Care

Pediatric Mental Health Care Access (PMHCA) Technical Assistance Program

Quality Improvement Tools

QI Office System Tools

Sample PDSA Cycle Worksheet

Data Collection Instrument for Anxiety and Depression Measures

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