Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Articles by Posner, J. Articles by Fullilove, M. J. PubMed Citation Articles by Posner, J. Articles by Fullilove, M. J. Outpatient Services Quality of Care, Practice Guidelines Medical Records Posttraumatic Stress Disorder Related Articles

Quality and Use of Trauma Histories Obtained From Psychiatric Outpatients: A Ten-Year Follow-Up

OBJECTIVE: In 1996 Eilenberg and colleagues reviewed 180 charts and reported that trauma histories were poorly documented at a general psychiatric clinic. This study is a ten-year replication of that work. METHODS: A total of 107 randomly selected charts from the same clinic were reviewed for assessment of trauma history. The quality of the assessments was rated. RESULTS: Fifty-six percent of charts contained a thorough description of trauma severity, compared with 15% in the initial study. Documentation of posttraumatic symptoms improved significantly in all categories but remained low. Documentation of diagnostic formulations and treatment plans for patients with a trauma history was thorough in a small proportion of charts (14%), as was found in the initial study (9%). CONCLUSIONS: Although some improvements were found in recording trauma histories, eliciting such a history did not lead to thorough documentation of posttraumatic symptoms or to inclusion of the history in the diagnostic formulation or treatment plan.

Related Articles:

The Importance of Assessing Exposure to Trauma

Robert J. Ursano and Charles C. Engel
Psychiatr Serv 2008 59: 229. [Full Text] [PDF]

Get information about faster international access.

Privacy Policy

Copyright © 2008 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us