Readiness Assessment as a D&I Strategy: Informing Universal Depression Screening Implementation in Schools

Adolescent depression rates have increased dramatically over the past decade, yet screening rates remain low even in schools, where near-universal screening rates can be achieved. In New Jersey, ten school districts were selected to pilot a program designed to implement universal depression screening for adolescents in grades 7-12, with parent consent. In line with D&I principles, we conducted a readiness assessment to understand the acceptability, feasibility, barriers, and facilitators for universal adolescent depression screening prior to the state's rollout.

This mixed-methods study surveyed school-based mental health professionals (n=70) and interviewed key informants (n=15). The survey assessed current practices, perceived feasibility, acceptability, and anticipated barriers; results were analyzed using descriptive statistics, chi-square tests to examine differences across practitioner sub-groups, and a logistic regression model to predict practitioner readiness. Interviews explored implementation requirements and necessary supports and were analyzed using a six-step thematic analysis.

While 62% of practitioners perceived adolescent depression as common in their schools, fewer than 5% reported routine screening practices. Practitioners strongly endorsed universal screening as feasible (87%), effective for identifying depression (86%), and research-based (82%). However, they anticipated significant barriers: limited capacity for follow-up services (63%), insufficient staffing and resources (61%), lack of standardized instruments (61%), and challenges providing real-time intervention (60%). Fewer than 40% expected parent support. Interviews revealed critical needs for explicit procedural guidance, dedicated funding, staff training, clarity on responsibilities following positive screens, and strategies for engaging parents. Practitioners emphasized that successful implementation would require comprehensive infrastructure support beyond screening mandates.

This study demonstrates how pre-implementation assessments can maximize the impact of evidence-based interventions by proactively identifying key implementation considerations. Findings provide actionable intelligence for policymakers to address challenges and enable implementers to benefit from practitioner-informed program design. Future D&I research examining if and how such assessments ultimately influence implementation success and sustainability is promising and is underway within this initiative. Such assessments represent a valuable D&I strategy for complex and system-level mental health interventions, enabling proactive resource planning and stakeholder engagement to realize the full public health impact of evidence-based practices.