Implementing Posttraumatic Stress Disorder Screening at an Adult Substance Use Disorder Clinic

Abstract

Problem & Purpose: Posttraumatic stress disorder (PTSD) is a prevalent co-occurring disorder among substance use disorder patients. Often, urban substance use disorder clinics do not screen for PTSD, and patients are not referred to available mental health services unless in crisis. When PTSD is left undetected and unaddressed, it adversely affects patients' symptoms severity and treatment outcomes. The purpose of this quality improvement project was to identify adult substance use disorder patients with probable PTSD using the Primary care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PC-PTSD-5), and evaluate the effectiveness of the screening to trigger referral for additional mental health assessment. Methods: The project occurred over 12 weeks and included all qualified substance use disorder patients, 18 years, and older in an urban, outpatient substance use disorder clinic. Screening was implemented by a team of champions trained in the administration and scoring of the Primary care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PC-PTSD-5). Education regarding PTSD symptoms was required for all screened patients. Data were analyzed using descriptive statistics of the sample and a Chi-square test to determine the association between referral and PC-PTSD-5 score. Weekly progress of screening, referral, and education was tracked using a run chart. Results: Of the 116 eligible patients, 62 were screened for PTSD. Thirty-five screened patients received a referral for further assessments. A chi-square test of independence was performed to examine the relation between PC-PTSD-5 score and referral. The relation between these variables was significant, X2 (2, N = 62) = 11.2, p = .0037. Patients with a higher PC-PTSD-5 score were more likely than those with a lower score to receive a referral for further mental health assessment. Conclusions: The PC-PTSD-5 screening tool was successful at increasing mental health services awareness and utilization by substance use disorder patients through the score-based referral process. PTSD screening and score-based mental health referrals were recommended to become standard practice. Digitalization and integration of the screening tool in the electronic health record are instrumental in ensuring sustainability and compliance.