Quality Improvement Project: Improving Pediatric Vitamin D Screening and Treatment in a Mental Health Clinic

Background Adequate levels of vitamin D have shown to play a significant role in the overall physical and emotional well-being of both adults and children. However, vitamin D deficiency is highly prevalent throughout the pediatric population, with nearly 60 percent having suboptimal vitamin D levels. Research indicates that vitamin D deficiencies stem from a lack of screening and treatment, which underscores the need for standardized guidelines for pediatric screening for Vitamin D deficiency.Methods A quality improvement project was developed to address the lack of standardized vitamin D guidelines. Mental health providers at a local pediatric mental health clinic were assessed regarding their knowledge of vitamin D and the clinic's current status of vitamin D screening and treatment. An educational toolkit that included a testing and treatment algorithm, was created to provide a readily available resource for clinic staff. To assess the interventions implemented, pre- and post-surveys were given to participants to determine the effectiveness of the education. Additionally, two reviews of the clinic's EHR system was completed to assess the providers' engagement and identify pre- and post-intervention vitamin D testing and treatment within the clinic. Results Following the implementation of interventions, the study found that staff members (n=9) had a percentage increase of 27.4% in correct answers on the post-educational survey, indicating an increase in knowledge. While no question demonstrated a statistically significant increase (partially attributable to the low sample size), all changes were positive. It was also found, through the EHR review, that four additional patients had received vitamin D screening and four additional patients were taking vitamin D approximately a month after the addition of the new guidelines. The Follow-Up Usability and Feasibility Survey revealed an increase in patients screened for vitamin D and received treatment. More specifically, providers reported an additional nine patients were referred for testing, and six additional patients received treatment.Conclusions Utilizing the educational toolkit within the clinic setting appeared to be valuable in increasing the staff member's education and engagement to reduce vitamin D deficiency and improve mental health outcomes for children and adolescents. Due to the sample size of this study being small and limited, additional studies with larger sample sizes need to be completed to determine generalizability and translatability. Clear education and guidelines surrounding vitamin D testing and treatment are a needed and valuable resource for pediatric mental health providers.