Checking IN

Pediatric digital distress screening measure

Developed by researchers in the Pediatric Oncology Branch of the National Cancer Institute (NIH NCI), National Institute of Mental Health (NIMH) and technology through Patient Planning Services & Cancer Support Community. Checking IN is an evidence-informed digital distress screening solution for pediatrics.

The evidence-informed tool is a web-based distress screening measure for patients (age 8-21) with chronic medical conditions and their parents. The tool is currently available in English and is designed to provide real-time results/feedback to clinical providers and patient distress and how parents perceive their child’s distress.

Checking IN was developed due to several challenges that were unique to pediatrics in an outpatient setting: 

  • No real time solution existed for identification of psychosocial problems due to busy clinic days.
  • Staffing and bandwidth are large issues and with fewer resources not every child can be seen by a mental health professional.  
  • Finally, a brief measure was needed to establish acuity (those who really needed help right way). 

Research showed that for tools that did exist there were limitations for children, namely in the areas of:

  • Did not assess for symptom interference or suicidal ideation
  • Kids don’t like the word “distress”
  • Not available electronically
  • Feedback to provider needed

  • Quality & Efficiency (Feasible)

    Feasible electronic distress screener for dyads to assess the needs of the whole child. Having access to the information in real time allows clinical team immediate actionable interventions based on the domains endorsed (physical pain, sleep, and fatigue; emotional anxiety, depression, and suicidal ideation; body image; cognitive, attention/concentration; school concerns; family problems; medication adherence and access to support).

  • Patient Experience (Acceptable)

    Real-time access to this important information allows early identification of pertinent issues with acuity as described by the patient themselves. With self-reporting patients feel heard and it allows for appropriate resource allocation for a better patient experience. Minimal completion burden as measure is easy to administer and complete. Clearly highlights patients' highest concerns for care team.

  • Provider Experience (Useful)

    Real-time feedback and triage of highest acuity patients allows providers to focus on highest need patients. Automated tracking of endorsed domains over time provides clear identification of trends, problem areas, and psychosocial risks. Automated referrals to support resources saves time and streamlines visits.

Frequently Asked Questions

  • Why screen for distress in pediatrics?

    Endorsed by professional organizations
    Endorsed: National Comprehensive Cancer Network (NCCN), International Psycho-Oncology Society (IPOS), and International Society of Pediatric Oncology (SIOP).

    Meet accreditation standards
    Cancer programs seeking accreditation from the American College of Surgeons Commission on Cancer are being monitored for their adherence to standards for patient-centered care that include distress screening and referral for psychosocial services
    (Jacobsen, JCO, 2012, 2015).

    Industry best practice, standards of care
    Clinical best practice standard of care – supported by 149 studies
    (Kazak, et al., PBC, 2015)

  • What are the objectives of the measure?
    • Improve patient quality of life
    • Improve treatment adherence and/or identify barriers
    • Provide a tailored/personalized intervention plan based on real-time patient & caregiver feedback/voice
    • Fulfills Standards for the Psychosocial Care of Children with Cancer and Their Families
  • Is the tool validated?

    The tool is not currently validated as there are no similar tools available to validate against. It has completed the following Phases:

    Phase I: (Research with NIH & Georgetown).

    Assessment of adapted Pediatric Distress Thermometer (DT) in outpatient setting

    N = 289

    Main findings: Children endorsed differing levels of distress & domains than parents AND PROVIDERS.

    Designed to capture three perspectives : 1) parent 2) child 3) provider

    Phase II: Development of revised pediatric distress screen (Checking IN)

    Items within 6 domains were developed: Physical, Emotional, Cognitive, Social, Spiritual, Practical

    Conducted cognitive Interviews (8-12; 13-17; 18-21 age groups)

    Comprehension, clarity, response choices tested; formatting and design changes documented

    Phase III: Feasibility, Acceptability, Usefulness (National Institutes of Health, Children’s Hospital Colorado, Levine Children’s Hospital, The John Hopkins Hospital). 

    Assess feasibility and acceptability of administering electronic version for dyads in an outpatient setting, perceived burden and benefits, usefulness of summary report, and acceptability of implementing suicide screening.

  • How much does it cost to license Checking IN?

    The tools are licensed on an annual subscription basis. The pricing is based on clinic volume. We are happy to send a non-obligatory proposal.

  • Are they customizable if we want to add surveys or question sets?

    Checking IN is a measure that is research based and has been studied for feasibility, usability and usefulness. While you cannot change the core questions or measure, you can add additional surveys or question sets to the platform.  These would populate in drop down menu and you could select whichever measure you want to launch from the menu to include the Checking IN pediatric screener measure. We are happy to work on custom surveys for you (i.e. opioid use, COVID questions, population health, health care disparities).

  • Do you have funding or grants available to help offset the cost of the license?

    We do not provide funding. We encourage you to talk with your foundation, marketing department, or IT department to explore funding options if your service line budget does not have room for technology growth.