Peer-reviewed article
A longitudinal mixed-methods study of barriers and facilitators to the implementation of routine PTSD screening for care-experienced young people.
Rosie McGuire, Richard Meiser-Stedman, Patrick Smith, Davin Schmidt, Gretchen Bjornstad et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001Care-experienced young people (children in foster care or out-of-home care) have high rates of post-traumatic stress disorder but their symptoms often go undiagnosed. This study tracked 243 mental health professionals across 28 teams in England over 12-18 months to understand why a validated screening tool (CRIES-8) was not being used consistently with this vulnerable group, even after training. While most professionals used the screening tool overall, only half used it with care-experienced young people, mainly due to limited staff capacity, limited access to services, and staff beliefs about diagnoses. The study found that flexible and proactive teams were more likely to implement the screening successfully.
Key points
- 80% of trained professionals used the CRIES-8, but only 50% used it with care-experienced young people
- Use was sporadic and inconsistent despite training
- Main barriers were staff capacity, young people's access to mental health services, and professionals' beliefs about diagnoses and routine outcome measures
- Flexibility and proactivity among team members were important facilitators for implementation
- Different implementation methods had varying impacts on service resources and completion rates
Limitations
The study examines barriers to implementation of a screening tool but does not measure whether the screening tool itself improves outcomes for care-experienced young people. The research focuses on England and may not reflect implementation challenges in other countries or healthcare systems.
Abstract
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.