Implementation of a School Nurse-Led Case-Finding and Targeted Anxiety Testing Protocol (SBIRT-Informed) in an Elementary School: A Quality Improvement Initiative

Anxiety disorders are among the most common pediatric mental health concerns, affecting nearly one in ten U.S. children, and often present as unexplained somatic complaints in school health offices. In rural Montana, limited access to behavioral health care compounds these challenges. This quality improvement project tested a nurse-led case-finding protocol (≥3 unexplained somatic visits in 6 weeks) followed by targeted anxiety screening using the Screen for Child Anxiety Related Emotional Disorders (SCARED) administered in both child self-report (SCARED-c) and parent-report (SCARED-p) versions, within a Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework. Of 430 students, eight met case-finding criteria, six completed screening, and five screened positive. All received a nurse-delivered brief intervention and counseling referral. Guided by Plan-Do-Study-Act cycles, the project demonstrated feasibility, sustainability, and the critical role of school nurses in early anxiety recognition within resource-limited settings.