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

Faculty Information:

Date:

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?

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.

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.).

Please provide a description of your data security plan for both physical and electronic data that includes protected or identifying personal information. Include where the data will be stored, the security of the location or computer system, the length of retention of the data, and the method of disposition of old data.

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

352-428-7472

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?

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

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.

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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 data from the DASS21.

The completed DASS21 will be collected by the DNP student and reviewed to determine individualized care plans.

Permission to utilize DASS21 is not required as it is a public domain. Copies of the tool will be printed and readily available for use with patients that come in for their mental health appointments.

Please provide a description of your data security plan for both physical and electronic data that

includes protected or identifying personal information. Include where the data will be stored, the

security of the location or computer system, the length of retention of the data, and the method

of disposition of old data.

The list of patients that are seen by the DNP student will be kept in the students locked protected file on hard drive.

The data collected as part of the project will not include any protected or identified personal information.

The DNP student has developed a checklist to monitor and record the number of patients for whom DASS21 was implemented.

Additionally, the DNP student has developed a tracking sheet to determine the number of patients for whom the DASS21 Indicated a need for psychotherapy stress remedies and the number in which this was appropriately appropriated executed.