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Implementing the Child Trauma Screen into an inpatient Pediatric Psychiatric unit

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2024-05
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Problem: Two-thirds of all children experience trauma before the age of 16. Without screening, many cases go unreported and untreated, worsening trauma symptoms. Only 35% of patients admitted to a pediatric psychiatry unit in a large teaching hospital of an urban district are screened for childhood trauma. The site lacks standardized screening tools to assess for childhood trauma amongst children of all ages of admission (6-17 years old). Screening for childhood trauma can personalize treatment plans and improve patient care. Published evidence demonstrates that childhood trauma can be accurately identified using the reliable and validated Child Trauma Screen (CTS) tool. Purpose: The purpose of this Quality Improvement (QI) initiative was to implement the CTS on a pediatric psychiatry unit during the admission process from September 11th, 2023 until December 22nd, 2023. Methods: The 10-item CTS tool was integrated into electronic health record (EHR) and individualized treatment plans (ITP) for all patients with moderate (7-12) to high trauma scores (13-18) were established. The implementation team consisted of project lead (PL), clinical site representative (CSR), psychologist, 14 registered nurses, 2 nurse practitioners and 2 attending psychiatrists. The CTS was completed within 24 hours of admission to unit by registered nurses (RN). PL conducted regular meetings to provide feedback and give continuous updates regarding QI progress. Chart audits were completed weekly by PL on all admitted patients. Data retrieved were entered electronically into REDCap by PL in private location at the clinical site. Identifiers were coded by REDCap and only accessible to PL. Results: All RNs staff completed the education sessions on childhood trauma and CTS’ utilization; 98% of admitted patients were screened and a trauma score was generated in their EHR; 94% received individualized treatment plans (additional therapy sessions, parent child trauma sessions, trauma psychoeducation). Conclusions: Findings support integration of the CTS tool into work flow as it has accurately identified childhood trauma symptoms, generated trauma scores, and helped develop ITP for all admitted patients.

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