A Symptom-driven Treatment Pathway for Post-traumatic Stress Disorder Management in the Juvenile Detention Setting

Incarcerated juveniles experience disproportionate exposure to traumatic events compared to the general population. It is estimated that nationally, up to 90% of all juvenile justice-involved individuals have had some exposure to a traumatic event and that 30% meet the criteria for post-traumatic stress disorder (PTSD). When unidentified, post-traumatic stress symptoms can influence the chances of recidivism among this population. While correctional facilities can adopt methods of trauma-informed care, there is currently no blueprint for PTSD treatment recommendations that can be offered to youth in the juvenile detention setting. Local Problem: The Juvenile Justice and Youth Services detention setting has collected the PTSD screening inventory on all youth entering the facility over the last four years. While a high proportion of youths have a positive screening, the results have not been used to guide treatment recommendations offered to them while in the detention setting. Long-term residents are eventually offered treatment options, but care for short-term residents is insufficient. Methods: This quality improvement project aimed to identify Juvenile Justice and Youth Services detention youth at risk for developing PTSD and create a pathway to guide treatment options for them while in detention. Pre-implementation assessments helped identify the treatment team's view of the current process, which helped determine what treatment recommendations would be offered within the symptom-driven treatment pathway. A post- implementation assessment, final questionnaire, and team discussions identified the team's experience with the new process. Retrospective chart reviews evaluated the steps taken to provide treatment to these youth and how the process had changed from pre-intervention admissions to admissions during the implementation of the intervention. Interventions: A symptom-drive PTSD treatment pathway was created to guide what treatment options would be presented to youth who screened positive on the PTSD screening inventory. Results: Retrospective chart reviews produced insufficient evidence to determine whether the symptom-driven PTSD treatment pathway improved treatment offered to detention youth with a positive PTSD screening inventory. The treatment team identified successes of this quality improvement project, including the use of the PTSD screening inventory to identify youth presenting with post-traumatic stress symptoms, education and resource pamphlets provided to released youth and their families, the pathway visual, and identification of the youth's outpatient services. The team concluded that insufficient staffing and educating per diem nurses on the new process were areas for improvement. Finally, most of the team felt the new process was easy to use and could be implemented in other detention facilities. They also found it sustainable to keep aspects of the new process for long-term use. Conclusion: The symptom-driven PTSD treatment pathway was successful in utilizing the PTSD screening inventory to identify youth presenting with post-traumatic stress symptoms who are at risk for developing PTSD. It also offered treatment recommendations based on what services the youth were previously receiving and their estimated length of stay. The treatment team identified aspects of the symptom-driven PTSD treatment pathway that were successful and could be implemented in other detention facilities in the future. It has not been determined whether this process change will be continued in this JJYS detention setting.