Date of Award

Spring 2020

Degree Type


Degree Name

Doctor of Nursing Practice (DNP)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Carolyn Coleman

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Dr. LaWanda Baskin

Committee Member 2 School

Leadership and Advanced Nursing Practice

Committee Member 3

Dr. Carolyn Holloway

Committee Member 3 School

Leadership and Advanced Nursing Practice


Increased efforts are being made to move individuals with co-morbid medical and psychiatric diagnoses toward integrated care. Lack of consistent screening in primary care has caused missed opportunities to identify depression during a routine healthcare provider visit. This project sought to implement a practice strategy in primary care using an assessment tool to screen for depression. Interviews were used to ask patients to answer two questions related to the frequency of depressed mood in the last two weeks. The project was seeking to show by screening patients in primary care for depression, the number of referrals to behavioral health would increase and early intervention could be initiated.

Integrating behavioral health services within primary care creates a continuum of care and improves both mental and physical health for adults. Screening and early intervention can positively change both medical and mental conditions. The population, Intervention, Comparison, Outcome and Time (PICOT) question for this project was, in a Native American population, does the use of a screening tool, Patient Health Questionnaire (PHQ2) during primary care visits, encourage patients to report mental health issues when compared to patients who are not being screened? The outcome of the project was for 343 patients seen in the clinic, 281 patients consented to be screened, and two patients were referred to behavioral health during the project. In comparison, only one patient was referred to as behavioral health from primary care in November 2019. A small improvement in screening patients in primary care for depression was noted during the project; however, more training is needed with the staff. More consistent policy and closer collaborations between the two departments can move the level of integration from a level 3 to level 4 of the Integrated Practice Assessment Tool (IPAT).

Creating an electronic system of referrals to behavioral health services promote effectiveness and timeliness. Native American patients in primary care are more likely to report depression when asked directly than those who are not asked. For the patients who score over 3 on PHQ2, a follow-up plan was in place.