Optimizing Mental Health Referral and Follow-Up for Pediatric Trauma Patients.

Abstract

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.