Integrating Mental Health Services in Primary Care: A Solution to Limited Access

Purpose: This quantitative DNP project evaluates the effectiveness of COPE, a seven-week cognitive-behavioral therapy (CBT) primary care intervention, in reducing anxiety and depression symptoms among adolescents aged 12-17 in a pediatric clinic setting. Background and Significance: Anxiety and depression rates among adolescents have significantly increased in recent years, leading to delays in care and exacerbating the shortage of available services. Integrating mental health into primary care settings provides a solution by expanding care access. Methods: The Health Promotion Model (HPM) by Nola Pender is the theoretical framework that guided the project. Adolescents who met the inclusion criteria outlined by the Arizona State University (ASU) Institutional Review Board (IRB) were recruited during routine visits by the clinic nurse practitioner. The program was delivered by a DNP student and trained team members to seven participants over several months. Anxiety and depression levels were measured using GAD-7 and PHQ-9, which are well-established and validated tools for assessing anxiety and depression at baseline, mid-intervention, and post-intervention. Of the seven participants, five dropped out before completion, leaving three participants who completed the full intervention (n=3). Outcomes/Results: The average pre-intervention GAD-7 score was 12.00 (SD = 3.46), the average mid-intervention score was 9.00 (SD = 6.24), and the average post-intervention score was 6.67 (SD = 3.79). For the PHQ-9, the average pre-intervention score was 12.00 (SD = 5.57), the average mid-intervention score was 11.33 (SD = 9.24), and the average post-intervention score was 7.67 (SD = 6.03). Given the small sample size, descriptive statistics were used to display the results instead of inferential statistics. Post-intervention results showed reductions in both GAD-7 and PHQ-9 scores compared to baseline. Conclusion: COPE demonstrated potential in reducing anxiety and depression symptoms, but the high attrition rate indicates a need for improved retention and recruitment strategies. Future research should explore barriers to program completion and assess the long-term effects of COPE on adolescent anxiety and depression.