Closing the Gaps: Behavioral Health Screening Intervention and Follow-Up in a Level I Trauma Center

INTRODUCTION: Substance misuse (SM) and mental health (MH) disorders are highly prevalent among trauma patients and are associated with increased mortality and recurrent injury. Despite national guidelines mandating behavioral health screening of at least 80% of admitted patients at Level I trauma centers, implementation remains challenging at urban safety net centers, which often lack dedicated behavioral health specialists and standardized referral pathways. METHODS: We conducted a single-center, pre-post quality improvement study evaluating an expanded behavioral health screening and intervention guideline at a Level I urban safety net trauma center. Adult trauma patients (aged ≥17 y) admitted December 2024 through December 2025 were eligible. The preimplementation period reflected our prior practice, which used blood alcohol level testing only. The intervention included standardized screening tools, advanced practice provider training, electronic medical record-integrated screening prompts, and embedded addiction medicine and MH specialists. RESULTS: Of 2207 admitted patients, 84.2% were eligible for screening. SM screening was completed in 77.2% of eligible patients and MH screening in 65.4%, compared to a preimplementation alcohol-only screening rate of 17% (P < 0.001). Among screen-positive patients, 89.5% received an SM referral, and 98.2% received an MH referral. Screening completion was notably higher for primary trauma service admissions (SM: 90.6%; MH: 80.1%) versus off-service admissions (SM: 49.6%; MH: 31.8%). CONCLUSIONS: Implementation of a multidisciplinary behavioral health screening guideline at an urban Level I trauma center resulted in improved and sustained screening, referral, and specialist contact rates. Compliance gaps among off-service admissions represent a critical target for future quality improvement.