From Triage to Treatment: Enhancing Mental Health Screening Compliance in Pediatric Trauma Patients

Kendall Snellgrove, MD
Isabella Masler, MD
Andrew Donahue, MD
Heather Austin, PhD
Nicole Jones, MD
Mark Baker, MD

Pediatric trauma can lead to serious mental health issues, but identifying at-risk patients is challenging. To address this, a Pediatric Emergency Department (PED) at a level 1 pediatric trauma center launched the PsySTART Pilot Project in June 2024. PsySTART is a validated triage tool that screens trauma patients for mental health risks and helps connect individuals at high risk to a 12-week trauma-focused cognitive behavioral therapy (TF-CBT) program. The tool satisfies the 2022 American College of Surgeons Trauma Center performance measure for a mental health screening on all trauma patients. However, following implementation, only 46% of triage forms were completed in the first five months, highlighting system inefficiencies. Incomplete screening may lead to missed follow-up care, raising concerns about equitable mental health support for all pediatric trauma patients.

This program aims to raise PsySTART triage form completion for pediatric trauma activations in a level 1 PED from 52% to 70% over 12 months. Using the Plan-Do-Study-Act (PDSA) quality improvement method, a multidisciplinary team identified key interventions, including a Just-in-Time training video and an electronic health record (EHR) reminder. Training completion and PsySTART form completion rates will be tracked, and an annotated run chart will track each intervention’s impact.

After the first PDSA cycle (Just-in-Time training video), completion rate dropped to 42%. Only 30% of eligible staff completed the training. After the second PDSA cycle (EHR reminder), completion rate increased to 71%. Overall completion rate is now 50% since PsySTART implementation. Prior to the first PDSA cycle, the percentage of patients referred to a mental health provider per trauma activation was 13%. This increased to 17% and 24% during the first and second PDSA cycle, respectively. 2 patients (1%) were referred to TF-CBT prior to the first PDSA cycle. 2 patients (4%) and 3 patients (5%) were referred to TF-CBT during the first and second PDSA cycle, respectively. 2 patients have completed TF-CBT and 2 are currently enrolled.

Implementing the PsySTART triage system revealed the importance and challenges of identifying pediatric trauma patients at risk for developing mental health complications. Despite low initial completion and training rates, targeted interventions—especially EHR reminders—led to improved PsySTART use and more referrals to specialized mental health care. Although training uptake remained low, the increase in PsySTART completion and subsequent referrals to mental health and TF-CBT providers suggests early progress toward more equitable and effective post-trauma care. Continued refinement is needed to sustain improvements and ensure timely access to appropriate post trauma mental health care.

1. Describe the purpose and function of the PsySTART triage tool in identifying high-risk pediatric patients and facilitating mental health referrals.
2. Evaluate the effectiveness in specific quality improvement interventions on PsySTART completion and subsequent referrals to mental health and TF-CBT services.
3. Compare the effectiveness of an educational intervention to a behavioral prompt during program implementation.