| Description |
Background: Adolescents are disproportionately affected by sexually transmitted infections (STIs), contributing to significant public health concerns. Early detection and treatment are essential for reducing transmission, preventing complications, and improving sexual health outcomes. Despite national guidelines recommending routine STI screening for sexually active adolescents, screening rates remain suboptimal, particularly in mental health settings. Adolescents in these environments often have behavioral risk factors and limited access to preventive healthcare, further increasing their vulnerability to undiagnosed and untreated STIs. Local Problem: A pediatric mental health facility in the western United States lacked a standardized STI screening protocol, relying solely on symptom-based screening rather than routine preventive screening. This approach failed to identify asymptomatic infections, leading to missed early detection and intervention opportunities. This quality improvement (QI) project aimed to implement a structured STI screening protocol during patient intake to increase screening rates and improve adherence to evidence-based guidelines. Methods: This quality improvement initiative was conducted over five months at a pediatric mental health facility serving adolescents aged 14 to 18. A pre-implementation staff survey (n = 23) assessed knowledge, attitudes, and perceived barriers to STI screening, while a retrospective chart review (n = 44 pre-implementation; n = 49 post-implementation) evaluated screening rates. The Plan- Do-Study-Act (PDSA) model guided implementation and adaptation strategies. Interventions: A standardized STI screening tool was developed and integrated into the patient intake workflow in November 2024. Nurses conducted initial screenings, escalating sexually active patients to nurse practitioners (NPs) for further assessment, testing, and treatment. Training materials were distributed to staff, including an online training module, FAQs, and patient education resources. Due to privacy concerns caused by facility reconstruction, a PDSA cycle in February 2025 expanded screening responsibilities to therapists who conducted screenings in private office spaces to enhance confidentiality and improve adherence. Results: Screening rates increased significantly following the intervention. Pre-implementation data revealed that 22.7% (10/44) of eligible patients were screened, while post-implementation data demonstrated an increase to 63.3% (31/49). The staff survey indicated that 86.7% of providers reported increased comfort discussing sexual health post-implementation, and 53.3% noted improved time constraints. However, privacy concerns remained, with only 46.7% of staff perceiving an improvement in confidentiality, while 53.3% felt there was no change. Conclusion: Integrating a standardized STI screening protocol into adolescent mental health care settings significantly improved screening rates and provider confidence. However, environmental barriers, particularly privacy concerns, continued to impact adherence. Future efforts should focus on structural modifications to enhance confidential screening environments and optimize workflow efficiency. Sustained multidisciplinary collaboration will be critical to addressing remaining barriers and ensuring long-term adherence to STI screening guidelines. |
