1.7 Screening Adolescents for Trauma and Traumatic Stress Symptoms at Annual Pediatric Wellness Visits: Implementation of a Standardized Screening Process

Abstract

Routine screening for childhood trauma in the pediatric primary care setting is recommended to identify youth at risk for negative physical and mental health sequelae. We sought to improve adolescent trauma screening in our urban, hospital-based pediatric primary care clinic by implementing the use of the Pediatric Traumatic Stress Screening Tool (PTSST), a validated screening tool for trauma and traumatic stress symptoms in children and adolescents. A survey to assess current resident practices established the need for a standardized trauma screening process in our clinic, because none existed. A clinical workflow was implemented to screen adolescents aged 11 years and older for trauma and traumatic stress symptoms using the self-complete adolescent version of the PTSST during well visits. Additional interventions included: 1) provider educational sessions; 2) a provider decision-making algorithm; 3) standard language for documentation of screening; and 4) a list of patient resources. We reviewed adolescent well visits conducted during the first 6 weeks postimplementation (n = 103) to gather data on weekly rates of documented PTSST screening and screening results. We also reviewed visits during the 6 weeks pre-implementation (n = 120) to compare pre- and postimplementation rates of referrals to mental health services and reports to the Administration for Children's Services (ACS) for safety concerns. Residents documented trauma screening using the PTSST at 19.4% of visits postimplementation (weekly range: 7%-46%). Of those adolescents screened, 25% reported a prior trauma (n = 5) with 80% of these endorsing moderate or severe symptoms of traumatic stress. All youth screening positive for trauma were referred for mental health services (n = 4) or already engaged in care (n = 1). Rates of adolescent mental health referrals were similar pre- and postimplementation (18.3% vs 15.5%). Screening resulted in the only ACS report made pre- or postimplementation. Our initiative to standardize and increase trauma screening using the PTSST led to the detection of adolescents with prior traumatic experiences and facilitated the identification of youth in need of mental health services. Future interventions will aim to increase provider engagement and education on in-office interventions for traumatic stress symptoms.