Abstracts

Rationale:
Children with epilepsy experience high rates of depression, anxiety, and suicidality, and they report lower quality of life, and higher rates of behavioral health difficulties. Despite evidence of such comorbidities, many are underdiagnosed and under-recognized. Though few studies have examined the process of implementing routine behavioral health screening and education within pediatric epilepsy clinics, results have indicated that such proactive measures may be beneficial to behavioral health and quality of life outcomes. In line with American Academy of Neurology guidelines, our interdisciplinary task force designed screening and intervention protocols for depressive and behavioral health symptoms in an outpatient pediatric epilepsy clinic. Our goal is to identify symptoms of depression and behavioral health needs in order to intervene prior to an acute crisis through a protocol that is scalable to a department level. 
Method:
A pilot protocol in an epilepsy clinic was developed based on review of literature and screening protocols in specialty and primary care settings. Typically developing children over 12 years of age will receive the Patient Health Questionnaire-2 item (PHQ-2) as an initial screen, followed by the Patient Health Questionnaire-9 item (PHQ-9) for risk categorization and management planning if indicated. In the absence of a brief screening tool for patients with intellectual disability (ID) or autism spectrum disorder (ASD), a caregiver screen was developed by this team to assess change and severity of behaviors. 
Results:
During an epilepsy clinic visit, neuro-typical patients are given PHQ-2 upon clinic visit check-in. If patient scores ≥ 2, the PHQ-9 is administered by the appointment provider. Symptom severity was categorized by score ranges as low, moderate, or high, each with accompanying intervention tracks. For patients with ID or ASD, a brief screen was administered to caregivers. For positive screens, the appointment provider is alerted for additional screening and assessment. Behavior severity is rated as low, moderate, or high with accompanying intervention tracks. Individualized interventions included: patient and family education, referral to social work, referral to community-based therapy, medication management, suicide risk assessment, referral to community or school based behavioral or ABA therapies, and safety planning. For acute mental health and behavioral symptoms, the standard hospital behavioral rapid response protocol is activated.
Conclusion:
Comorbid depression and behavioral health symptoms are common in pediatric epilepsy patients. Best practices include depression screening and intervention for all neurotypical patients and behavior screening of cognitively and socially impaired patients. Routine patient and family education regarding epilepsy and behavioral health is indicated. Next steps will include iterative scaling of the protocol throughout the Epilepsy Program and the larger Neuroscience Division. Further investigation will include measuring ED utilization for behavioral health crises and activation of acute crisis response for the intervention population.  
Funding:
:No funding was received in support of this abstract.