Project Title:

Doctorate Student Name:

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· Herzing University Student

· Student not affiliated with Herzing University – list institution this project is affiliated with: __________________________________

Email:

Primary Phone Number:

Location/Sponsor:

Faculty Information:

Faculty Name:

Faculty Email:

Faculty Phone:

Anticipated Start Date:

Anticipated Completion

Date:

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?

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.

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.).

Data Security

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Project Title:

Implementing an evidenced based scale that measures depression, anxiety and stress in an 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:

Wilkerson & Company LLC- Danielle Weitzer

Faculty Information:

Faculty Name: Colleen Bartlett

Faculty Email:[email protected]

Faculty Phone:

352-428-7472

Anticipated Start Date:

6–17-24

Anticipated Completion Date:

8-17-24

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 12 weeks, an evidence-based screening tool – the Depression, Anxiety, and Stress Scale (DASS21) – will be implemented in an established private mental health practice the project practice setting aimed at evaluating stress prevalence and offering identifying patients for whom psychotherapy stress remedies are appropriate for inclusion in the patient’s treatment plan to improve patient outcomes related to their mental health diagnoses.

I have questions . . .

If you are only interested in evaluating for ‘stress’ then are you only administering the stress scale questions or are you planning on administering all 3 scales?

On the DASS21 FAQ’s page I don’t see the interpretation of scores information, did you purchase the Manual to review the score interpretations? https://www2.psy.unsw.edu.au/groups/dass/DASSFAQ.htm

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.

Stress as a concept is widely discussed and known to be the major factor affecting mental health globally (WHO, 2019). Stress is detrimental to the individual’s overall well-being and can lead to certain mental disorders like depression and anxiety disorders (WHO, 2022). Chronic stress can worsen symptoms in patients that are diagnosed with psychiatric disorders. (American Psychiatry Association [APA], 2022).

As the owner and a provider in of an outpatient psychiatric clinic it has been noted that stress is a common theme with the DNP student’s patients. Research has shown that patients that have stress ranging from moderate to severe during clinical evaluation have higher chances of being diagnosed with depression or anxiety disorders (Smith, 2023).

Research has shown that the questions outlined in the DASS21 are effective in identifying depression, anxiety, and stress in patients (Smith, J. 2023).

The purpose of this project is to implement the use of the Depression, Anxiety, and Stress Scale (DASS21) in an established private mental health practice aimed at evaluating stress prevalence and offering psychotherapy stress remedies to improve patient outcomes related to their mental health diagnoses. 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.

Process measures will be utilized to evaluate the project outcomes.

The first process includes evaluating the percentage of patients identified for whom the DASS21 scale was implemented during their visit to the outpatient clinic.

The second process measure will evaluate the percentage of patients that received psychotherapeutic interventions for stress management compared to the percentage of patients for whom DASS21 demonstrated the need for individualized psychotherapy psychotherapeutic interventions for stress management was appropriate remedies.

Process evaluations will also include a narrative discussion of the feedback provided by the DNP student and medical director about the implementation of DASS21. The discussion will include the level of satisfaction and workflow related to the administration of the tool.

The last outcome measure will be to re-evaluate patients’ depression, anxiety, and stress levels using the DASS21 at their 4 week follow up appointments. (Beaufort, et al., 2017). Same question as previously posed – If you are only interested in evaluating for ‘stress’ then are you only administering the stress scale questions or are you planning on administering all 3 scales?

The predicted outcome is that the implementation of DASS21 will identify patients with worsening depression, anxiety, and stress (so in order to discern ‘worsening you would need to administer the DASS21 and get a baseline score for each of the 3 subscales and then re-administer it after a series of psychotherapy sessions, is that what you are planning on doing? This is why an 8 week intervention is not adequate.) to provide them with timely psychotherapy stress remedies. This will support a reduction in stress levels, improved mental health, and increased patient satisfaction.

These references support incorporating an evidence-based stress scale in a private mental health practice. What is missing from this reference list are references that demonstrate the development and validation of the DASS-21 form.

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

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

World Health Organization. (2019). Mental health: Strengthening our response. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Smith, J. (2023). The impact of stress on clinical evaluations and diagnoses of depression and anxiety disorders. Journal of Mental Health Studies, 45(3), 210-223.

.

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 PDSA framework will be used for this project.

The project will be conducted over 8 12 weeks.

The DNP student will serve as the implementation leader. The only other team member will be the medical director of the practice.

The focus is on all patients who present with a mental health diagnoses and range in age from 18-65.

The predicted outcome is that the implementation of DASS21 will identify patients with worsening depression, anxiety, and stress (see prior comment about discerning ‘worsening’) to provide them with timely psychotherapy stress remedies. This will support a reduction in stress levels, improved mental health, and increased patient satisfaction.

As previously indicated, two process measures and a narrative overview will be utilized to evaluate the projects’ outcome of individualized psychotherapy stress remedies with the da

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