A longitudinal mixed-methods study of barriers and facilitators to the implementation of routine PTSD screening for care-experienced young people.

Background

Care-experienced young people (CEYP) have higher rates of PTSD than their peers; however, their post-traumatic stress disorder (PTSD) symptoms are often missed. The Child Revised Impact of Events Scale (8 items; CRIES-8) is a well-validated and widely available screening tool, which could identify children at risk of PTSD.

Objective

This project aimed to understand barriers and facilitators for the use of the CRIES-8 with CEYP accessing mental health services, as a means of increasing their access to evidence-based support.

Methods

We recruited 243 mental health professionals from 28 mental health teams across England and provided training in the CRIES-8 and cognitive therapy for PTSD. Focus groups and interviews were conducted approximately every three months for 12-18 months, as well as a brief one-off questionnaire about implementation completed 6-9 months post-training. Qualitative data were analysed via thematic analysis.

Results

While 80% of the sample did use the CRIES-8, only 50% used it with CEYP, and overall use was sporadic and inconsistent. The main barriers included capacity, CEYP access to mental health services, and professionals' beliefs around diagnoses and routine outcome measures, particularly for CEYP. Flexibility and proactivity amongst the team were important facilitators. In practice, there were a variety of methods to implement the CRIES-8, each with a different impact on service resources and the young person completing it.Conclusions Further service-based research to develop and test methods to address the identified barriers is essential to ensure that CEYP receive access to best-evidenced, needs-matched treatments.