Table 8.

Challenges to routine psychosocial screening.

Challenge	Strategies for Addressing Challenge
Stigma	Assure acceptability of screening Make screening standard for all patients/families Provide education on comprehensive care Document patient and family satisfaction with screening
Unrecognized need	Discuss how screening can improve care/outcomes Demonstrate how screening aids care management Address discipline-specific concerns
Time	Determine actual time necessary to screen Create option for online administration at home Integrate screening into routine clinical processes Schedule appointments to accommodate time
Limited resources	Create algorithms for triaging high needs patients/families with existing resources Use aggregate data to argue for expanded psychosocial resources
Impact on workflow	Establish responsibility for questionnaire administration, scoring, and feedback to the family and the clinical team Create alerts for high-risk responses or profiles to prompt immediate attention Identify team member responsible for reviewing and coordinating response Integrate screening findings within electronic health record
Sustainability of screening	Continue to train providers to implement Monitor pathways of care Review utility of individual measures through assessment of their psychometric properties in the DSD population with ongoing refinement Utilize existing billing codes for “psychological testing” or engage insurers through contracting