Sexually Transmitted Infection (STI) Screening Upon Admission to an Inpatient Pediatric Behavioral Health Unit

Background: Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the United States, with those experiencing mental health challenges at particularly high risk due to factors such as substance use, unprotected sex, and potential underlying trauma. In a pediatric behavioral health unit, sexual health histories were rarely collected at admission, limiting the ability to identify patients' risk levels and provide timely STI screening. Purpose: This quality improvement project aimed to increase sexual health history documentation and STI screenings by implementing a standardized sexual health history script. Methods: Using a structured Plan-Do-Study-Act (PDSA) cycle, a trauma-informed script was developed to guide nurses taking sexual health histories during admission assessments. Staff training sessions addressed common barriers to discussing sensitive topics, provided trauma informed strategies, and age appropriate communication methods. Pre- and post-implementation chart reviews assessed changes in sexual health documentation rates and STI screening orders. Ongoing staff feedback was gathered biweekly and used to refine the script through iterative PDSA cycles. Results: Post-intervention data showed a notable increase in complete sexual health history documentation, accompanied by higher STI and pregnancy testing rates. Nurses reported greater comfort and confidence in discussing sexual health, demonstrating the effectiveness of both the script and supporting training. One previously undetected STI case was identified, underscoring the script's potential to facilitate earlier detection and treatment. Statistical analysis confirmed significant improvements in documentation completeness and test ordering. Conclusion: By integrating a standardized, trauma-informed sexual health history script and employing the PDSA framework for ongoing improvements, this project led to better documentation practices and higher STI screening rates among adolescents in a pediatric behavioral health unit. The low-resource, adaptable nature of the intervention suggests its feasibility for broader adoption in similar settings, ultimately contributing to earlier STI detection and improved patient outcomes.