Improving Treatment and Awareness of Adoptees in Residential Treatment: A Screening and Education Quality Project

Background: Two to three percent of people in the United States are adopted. These rates are higher among adolescents with serious mental illness in residential treatment centers (RTC), where rates range between 25%-30% percent. Despite these rates, mental health clinicians report limited education on the unique treatment needs of adoptees. Lack of education about the impact adoption has on one's mental health creates a detrimental service gap for this already-vulnerable population. Local Problem: Thirty percent of the nation's adolescent RTCs are in Utah. This high concentration of local clinicians treating adolescents in RTCs increases the need for a quality improvement intervention to offer improved care to clients impacted by adoption. Methods: We developed a quality improvement project to educate clinicians and promote universal screening for attachment style in a rural adolescent residential treatment center. We assessed clinician knowledge about adoption-related mental health; these discussions led to the development of educational material, including resources such as an attachment screening tool. In addition, we sent clinicians a post-implementation survey to determine the feasibility, usability, and value of the educational toolkit and screening tool in providing more specified and effective care to adopted clients. Interventions: We implemented an online educational tool kit and inserted an attachment screening tool into the electronic health record (EHR). The tool kit synthesized discussion topics to provide a readily available resource for clinicians. The insertion of the screening tool into the EHR allowed clinicians quick access to the Revised Experiences in Close Relationships Scale (ECR-R). Results: Post-intervention data showed that 100% (n=6) of clinicians reported that the information and screening tool provided in the project was valuable in clinical practice and indicated plans to continue to use project material in clinical practice. A chart review showed the universal screening of all 21 clients, including ten adoptees, with the ECR-R. In addition, clinicians documented the use of the content from the project in clinical practice an additional 27 times in the one-month project period. Conclusions: The educational tool kit and insertion of the ECR-R into the EHR are valuable resources to clinicians. Small sample size considered, increased access to education on attachment theory and adoption improves clinical practice. Replication of this quality improvement project is needed to determine if the material can improve clinical practice in various settings.