Optimizing Mental Health Referral and Follow-Up for Pediatric Trauma Patients
Jennifer K York1, Derek Krinock, Lesa Slaughter
1Author Affiliations: Division of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, Arkansas (Mrs York, Mrs Onarecker, and Dr Wyrick); Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Krinock); and Department of Trauma, Arkansas Children's Hospital, Little Rock, Arkansas (Ms Slaughter).
Insights
A new initiative improved mental health referrals for pediatric trauma patients. While many received appointments, follow-up care needs enhancement for better outcomes in child trauma survivors.
Area of Science:
- Pediatric Trauma Care
- Mental Health Services
- Public Health Initiatives
Background:
- Level I trauma centers must screen pediatric patients for mental health concerns.
- Limited guidance exists for implementing these mental health screenings in pediatric trauma cases.
- This study addresses the need for improved mental health support in this population.
Purpose of the Study:
- To evaluate a multicomponent initiative designed to enhance mental health referral and follow-up processes.
- To assess the effectiveness of interventions aimed at pediatric trauma patients aged 8-17 years.
- To identify factors influencing referral completion and appointment adherence.
Main Methods:
- Retrospective cohort study of 120 pediatric trauma patients (aged 8-17) with positive mental health screens.
- Intervention implemented at a Level I pediatric trauma center in the Southern US (Dec 2022 - Mar 2024).
- Outcomes measured included inpatient resource provision and outpatient follow-up rates.
Main Results:
- 64.2% of patients received a clinic appointment; social work consultation and trauma service discharge predicted higher appointment rates.
- 66.2% of scheduled patients attended their appointments; White race and higher Injury Severity Score were associated with adherence.
- Over 50% of patients and 20% of parents screened positive for posttraumatic stress, with 67% receiving resources/referrals.
Conclusions:
- The screening and resource provision process effectively identifies pediatric trauma patients at risk for psychosocial distress.
- The initiative shows promise in connecting at-risk youth with necessary mental health services.
- Further improvements are required to optimize referral completion and ensure consistent follow-up care for pediatric trauma patients.
Background:
Level I trauma centers are required to screen at-risk patients for mental health concerns and provide appropriate intervention and referral. However, there is limited guidance on implementing these recommendations in the pediatric trauma population.
Objective:
This study aims to evaluate a multicomponent initiative to improve mental health referral and follow-up in pediatric trauma patients.
Methods:
We conducted a retrospective cohort study evaluating a multicomponent initiative aimed at improving mental health referral and follow-up in admitted pediatric trauma patients aged 8-17 years with a positive inpatient mental health screen. The study was conducted in a Level I pediatric trauma center in the Southern United States between December 2022 and March 2024. Outcomes included the provision of inpatient resources and outpatient follow-up.
Results:
A total of N = 120 patients were included, of which 77 (64.2%) received a clinic appointment. Patients who had an inpatient social work consultation (n = 69, 89.6%, p = .023) or were discharged from the trauma service (n = 24, 55.8%, p = .002) were more likely to receive a clinic appointment. Of those scheduled, 51 (66.2%) attended their appointment. Factors associated with appointment adherence included White race (n = 32, 62.7%, p = .034) and higher Injury Severity Score (21.6 vs. 15.2, p = .010). Among attendees, over 50% of patients and 20% of parents continued to screen positive for posttraumatic stress, with 67% receiving mental health resources or referrals.
Conclusions:
Our screening and resource provision process effectively identifies pediatric trauma patients at risk for psychosocial distress. However, improvements are needed to enhance referral completion and ensure follow-up care.
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