This research paper revolves around the process of the quantification of bupivacaine in human plasma through the selection of a sensitive high performance liquid chromatography method. The extraction of bupivacaine and ropivacaïne as an internal standard from plasma was performed through the use of hexane along with iso-propylalcohol. After liquid-liquid extraction we moved straightforward to the process of the mobile phase in which we had a combination of acetonitrile and potassium dihydrogen phosphate (65:35, v/v). The separation was carried out on a reversed phase C18 column with UV-detector at 210 nm for bupivacaine and 230nm for the internal standard. This particular examination exhibited excellent linearity (r2=0.999) in peak response over the concentration range of 0.1–1.5µg/mL bupivacaine in human plasma. The mean absolute recoveries for 0.5 and 1.5µg/mL of bupivacaine in plasma using the present extraction procedure were 97.43% and 95.03%, respectively. The intra- and inter-day coefficients of variation in the plasma were less than 12% at the lowest, and less than 10% at other concentrations, and the percent error values were less than 6%. The method displayed a high caliber of sensitivity and selectivity for therapeutic monitoring concentrations of bupivacaine in human plasma.
Background: With an aging population, and most deaths due to a nonmalignant cause, there is urgency to review the nature of end-of-life care (EoLC) to minimize gaps in service provision. Early introduction of EoLC benefits patient and carers, so identification of those at risk of dying 6 to 12 months before death is highly desirable.
Objective: To identify the most predictive patient characteristics of a risk of death within 6 to 12 months as a precursor to developing a user-friendly primary care screening tool.
Design: Retrospective case–control study.
Setting/Subjects: Australian general practice. Cases were patients aged =70 years who died in the previous 5 years. Controls were matched for age and gender. Exclusion criteria were: no available practice records for the 18 months before death (cases) and data collection (controls); no corroborated evidence of death.
Measurements: Supportive and Palliative Care Indicators Tool (SPICT) indicators of deterioration in medical records.
Results: There were 215 deaths and 267 controls. The most predictive patient characteristics of a risk of death within 6 to 12 months are: deteriorating performance status, weight loss, persistent symptoms, request for palliative care or treatment withdrawal, impaired activities of daily living, falls ± fractured hip, neurological deterioration, advanced lung disease, and estimated glomerular filtration rate <30 mL/min/1.73 m2 with deteriorating health. Our predictive model has a sensitivity and specificity of 67% and 87%, respectively, with a predictive accuracy of 78%.
Conclusions: This model predicts risk of death within 6 to 12 months with acceptable reliability in a general practice setting and has the potential to be incorporated into clinical practice and electronic records.
CONTEXT: Early palliative care (PC) has been shown to improve the quality of life of children with cancer, yet referral practices by pediatric oncology providers remains inconsistent and few patients receive a formal PC consult.
OBJECTIVES: We sought to describe patient characteristics used by oncologists for PC referral and identify ways to improve PC integration into the care for children with cancer.
METHODS: This mixed-methods study used semi-structured audiotaped interviews to explore the patient or disease characteristics used by pediatric oncology providers to trigger PC referral. Conventional content analysis was applied to interview transcripts.
RESULTS: 77 participants with diverse experience were interviewed. Over 75% of participants reported that PC was consulted "too late" and cited communication and systems issues as the top barriers. A majority of participants (85%) stated that a screening tool would be helpful to standardize referral practices to PC. Characteristics such as poor prognosis (88%), symptom management (86%), comorbidities (65%), and psychosocial needs (65%) were commonly reported triggers that should initiate PC consultation. However, when presented with case scenarios that included these characteristics, participants did not consistently identify the PC triggers. Nearly 50% of participants stated they had received some formalized PC training, however only one third of these participants noted completing a PC rotation.
CONCLUSIONS: Our findings suggest that pediatric oncologists are committed to improving the integration of PC for their patients and that standardization of referral practices, through the use of a screening tool, would be of benefit. Additional PC education might reinforce pediatric oncologists' recognition of palliative care triggers.
OBJECTIVE: This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology.
METHODS: Semi-structured interviews were conducted with 38 family members of patients with advanced cancer (n=12) and bereaved family members (n=26) on when and how to effectively implement bereavement risk screening. Data was analyzed using thematic analysis.
RESULTS: Many participants indicated that they would be open to completing a self-report screening measure before and after the patient's death. Several suggested screening at multiple timepoints and the importance of follow-up. Participants viewed screening as an opportunity to connect to psychosocial support.
CONCLUSIONS: The findings suggest that family members appear supportive of sensitively-approached bereavement risk screening before and after a patient's death as an important component of quality psychosocial care. To optimize implementation, bereavement risk screening would involve screening at multiple timepoints and include follow-up. Findings suggest standardized risk screening using a brief, validated self-report tool would be a pragmatic approach to increasing access to bereavement care.
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed 'frailty', and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and perhaps require a different approach. Frailty assessment also presents an important opportunity for intervention, when followed by Comprehensive Geriatric Assessment (CGA) in those who require it. Generally, a two-step approach, with a short initial screening, followed by CGA, is advocated in geriatric oncology guidelines. This has the potential to optimise care of the older person, and may also reverse or slow the development of frailty. It therefore has an important impact on the patient's quality of life, which is especially valued in the context of palliative care. Frailty assessment also allows a more informed discussion of treatment outcomes and a shared decision-making approach. With regards to the radiotherapy regimen itself, there are many adaptations that can better facilitate the older person, from positioning and immobilisation, to treatment prescriptions. Treatment courses should be as short as possible and take into account the older person's unique circumstances. The additional burden of travel to treatment for the patient, caregiver or family/support network should also be considered. Reducing treatments to single fractions may be appropriate, or alternatively, hypofractionated regimens. In order to enhance care and meet the demands of a rapidly ageing population, future radiation oncology professionals require education on the basic principles of geriatric medicine, as many aspects remain poorly understood.
Despite efforts to improve access to palliative care services, a significant number of patients still have unmet needs throughout their continuum of care. As such, this project was conducted to increase recognition of patients who could benefit from palliative care, increase referrals, and connect regional sites. This study utilized Plan-Do-Study-Act cycles through a quality improvement approach to develop and test the Palliative Care Screening Tool and aimed to screen 100% of patients within 24 hours who were admitted to selected units by February 2017. The intervention was implemented in 3 different units, each within community hospitals. Patients 18 years or older were screened if they were admitted to one of the selected units for the project, regardless of their diagnosis, age, or comorbidities. The percentage of newly admitted patients who were screened and the total number of palliative care consults were assessed as outcome measures. The tool was met with varying compliance among the 3 sites. However, there was an overall increase in consults across all hospital sites, and an increase in the proportion of noncancer patients was demonstrated. Although the aim was not reached, the tool helped to create a shift in the demographic of patients identified as palliative.
PURPOSE: Little information exists on factors that predict opioid misuse in oncology. We adopted the Screener and Opioid Assessment for Patients With Pain-Short Form (SOAPP-SF) and toxicology testing to assess for opioid misuse risk. The primary objective was to (1) identify characteristics associated with a high-risk SOAPP-SF score and noncompliant toxicology test, and (2) determine SOAPP-SF utility to predict noncompliant toxicology tests.
METHODS: From July 1, 2017, to December 31, 2017, new patients completed the Edmonton Symptom Assessment Scale (ESAS), SOAPP-SF, and narcotic use agreement. Toxicology test results were collected at subsequent visits.
RESULTS: Of 223 distinct patients, 96% completed SOAPP-SF. Mean age was 61 ± 12.7 years, 58% were female, 68% were White, and 28% were Black. Eighty-three eligible patients (38%) completed toxicology testing. Younger age, male sex, and increased ESAS depression scores were associated with high-risk SOAPP-SF scores. Smoking habit was associated with an aberrant test. An SOAPP-SF score >= 3 predicted a noncompliant toxicology test.
CONCLUSION: Male sex, young age, and higher ESAS depression score were associated with a high SOAPP-SF score. Smoking habit was associated with an aberrant test. An SOAPP-SF of >= 3 (sensitivity, 0.74; specificity, 0.64), not >= 4, was predictive of an aberrant test; however, performance characteristics were decreased from those published by Inflexxion, for >= 4 (sensitivity, 0.86; specificity, 0.67). The specificity warrants caution in falsely labeling patients. The SOAPP-SF may aid in meeting National Comprehensive Cancer Network recommendations to screen oncology patients for opioid misuse.
Background: Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools.
Objective: To identify outcomes associated with specialty palliative care referral among patients with critical illness.
Methods: Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care.
Results: Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation ( 2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult ( 2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult ( 2 = 19.39, P < .001).
Conclusions: Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.
La majorité des patients COVID-19 hospitalisés ont plus de 70 ans et 50 % de ceux qui en décèdent ont plus de 83 ans. La clinique typique n’est pas toujours présente chez les personnes très âgées qui peuvent être et rester totalement asymptomatiques (dépistage contact) ou avoir des manifestations aspécifiques (baisse de l’état général, chutes, delirium, fatigue). Le frottis anal, qui minimise le risque d’exposition, peut s’avérer très utile en EMS lors de diarrhées. L’âge avancé est un marqueur de mauvais pronostic, mais devrait être pondéré à l’aide d’index pronostiques pour tenir compte de l’hétérogénéité de l’état de santé, fonctionnel et cognitif à l’âge avancé. Recueillir les souhaits de la personne et évaluer son espérance de vie restante permet d’anticiper les décisions de soins selon le niveau de tension du système de santé.
OBJECTIVE: To evaluate sleep disturbances and to verify the accuracy of three screening tests to detect them in patients at the end-of-life admitted in a hospital palliative care unit.
METHOD: The level of sleep disturbances was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in 150 palliative patients. This questionnaire was the criterion variable for testing the three screening tests used: Edmonton Symptom Assessment System (ESAS-Sleep subscale); the single question "How much do you worry about your sleep problems?" which is answered on a scale of 0-10 (Sleep-Worry-Q) and another single question: "Do you think you have sleep problems?" with two response categories, Yes/No (Sleep-Problem-Q).
RESULTS: According to the PSQI (cut-off point: 8), 87% of patients presented sleep disturbances. The ESAS-Sleep (cut-off point: 3) showed a sensitivity of 0.87, a specificity of 0.58, and an AUC of 0.729; the Sleep-Worry-Q (cut-off point: 4) showed a sensitivity of 0.95, a specificity of 0.68, and an AUC of 0.854; the Sleep-Problem-Q obtained a sensitivity of 0.92 and a specificity of 0.65.
SIGNIFICANCE OF RESULTS: Patients at the end-of-life, near the time of death, have high levels of sleep disturbances that can be detected early, with better diagnostic accuracy, with the Sleep-Worry-Q. Although from a clinical point of view, the application of the Sleep-Problem-Q may be more advantageous, as it presents good diagnostic accuracy, greater simplicity, and brevity.
Advanced cancer patients are at an increased risk of developing depressive symptoms, which can lead to major depressive disorder and a poor quality of life. It is important that symptoms of depression to be addressed early and frequently throughout the trajectory of the disease process. Depression is underdiagnosed and therefore undertreated in advanced cancer patients. Clinicians often fail to perform regular depression screenings as recommended by the National Comprehensive Cancer Network. Depressive symptoms are overlooked as they tend to overlap with the effects of disease progression and cancer treatments. Patients' complaints of anorexia, chronic pain, and sleep disturbances do not necessarily trigger practitioners to perform depression screenings. African Americans with advanced cancer are at a higher risk of developing depression, but may not identify as depressed due to the stigma of mental health in the black community. Screening tools such as the 2- and 9-item Patient Health Questionnaire, Beck Depression Inventory II, Hospital Anxiety and Depression Scale, and the Distress Thermometer and Problem List are common brief instruments that can screen for depression. Providing early symptom relief of depressive symptoms through psychotherapy and pharmacologic interventions will benefit the patient, family, and caregivers while improving the quality of life throughout the trajectory of the illness.
Background: Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process. We aimed to evaluate the performance of a identification tool (based on the Gold Standards Framework Prognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South Africa.
Methods: Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa were enrolled in a prospective observational study. Demographic data were collected from patients and patient notes. Patients were assessed within two days of admission by two trained clinicians who were not the primary care givers, using the identification tool. Outcome mortality data were obtained from patient folders, the hospital electronic patient management system and the Western Cape Provincial death registry which links a unique patient identification number with national death certificate records and system wide electronic records.
Results: 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified using the screening tool as being in the last year of their lives. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68–81%), specificity of 85% (83–88%), a positive predictive value of 56% (49–63%) and a negative predictive value of 93% (91–95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87–16.9, p < 0.001).
Conclusions: The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst young patients, the majority under age 60.
Interventions for bereaved children and families range from supportive counseling, designed to promote social connectedness and expression of feelings and thoughts about the deceased, to intensive trauma/grief-specific therapy, designed to ameliorate symptoms of posttraumatic stress disorder (PTSD) and depression. That said, professionals have few brief assessment instruments to match response and functioning to appropriate interventions. To expedite the screening and referral process for bereaved families, Brown, Goodman, and Swiecicki (2008) developed the PTSD and Depression Screener for Bereaved Youth, a 19-item measure of bereavement-related history and symptoms of PTSD and depression. The current study is a psychometric evaluation of the Screener for Bereaved Youth. Data were collected from 284 bereaved children, 6–17 years of age (M = 12.4; SD = 2.9). A factor analysis revealed distinct subscales for PTSD (eight items) and depression (four items). The PTSD and depression subscales showed both concurrent and discriminant validity. Endorsement of four items on either subscale was associated with meeting full criteria on more extensive measures of PTSD and depression. These findings are discussed with specific consideration to the multiple systems in which the measure could be used and applications to clinical services.
BACKGROUND: Novel models that improve generalist-level palliative care for cystic fibrosis (CF) are needed to address the burden of this illness. A screening-and-triage model has the potential to identify clinical problems requiring immediate follow-up by CF professionals. This study describes such a model and its immediate impact on care delivery for CF patients during a two-year period.
METHODS: Eligible adults completed monthly online screening for sources of distress. If results revealed one or more "indicators of concern" on two consecutive screenings, this triggered an attempted triage by a social worker. Completed triages led to prompt follow-up by CF professionals for clinical problems, if indicated. Process data were summarized and generalized linear mixed models were used to evaluate baseline patient characteristics (symptom distress, quality of life, and sociodemographics) associated with the need for prompt follow-up.
RESULTS: A total of 1,015 monthly surveys were completed by 74 patients; 634 (66 patients) had >1 indicators of concern; and 164 surveys (46 patients) had >1 indicators for two consecutive surveys (e.g., global distress, pain, dyspnea, and psychological symptoms). The 164 attempted triages yielded 84 completed triages (51.2%), of which 39 (46.4%) required prompt follow-up. In multivariable analyses, older patients and those with higher symptom distress at baseline were more likely to require prompt follow-up (p < .05).
CONCLUSIONS: Web-based screening that assesses varied domains of distress or burden can identify a subset of CF patients whose clinical problems may benefit from immediate medical or psychological attention. Additional investigations should improve screening efficiency.
The aim of this study was to develop and trial a screening tool to increase palliative care referrals for hospitalized patients with chronic obstructive pulmonary disease (COPD) at a community hospital. Baseline data were collected retrospectively to determine the palliative care referral rate of patients with COPD at a high risk for readmission using the LACE index. A palliative care referral tool was developed to screen the patients who were at a high risk for readmission for palliative care referral. A 3-month pilot project prospectively evaluated the palliative care referral rate after educating staff on the use of the screening tool and implementing its use. During the baseline study, 2 palliative care referrals were placed out of 19 patients who were deemed appropriate by the screening tool (10.5%). During the pilot project, 16 palliative care referrals were placed out of 45 patients who were deemed appropriate by the screening tool (35.6%). Emergency room visits and readmissions were not significantly different between those with palliative referrals and those without. Barriers to palliative care referral were explored. The improvement in palliative care referrals, which occurred after the introduction of the consensus-driven screening process for patients with COPD, suggests the possibility of improved patient care using this model.
BACKGROUND/PURPOSE: Very few studies have investigated the screening tools that aim to identify the need of palliative care services among patients with advanced cancer or chronic non-malignant diseases. This study validated the one-page Taiwanese version-Palliative Care Screening Tool (TW-PCST) for screening inpatients with potential palliative care needs.
METHOD: ROC curves were produced to examine the sensitivities and specificities at varying cut-off points. The optimal cut-off value to predict mortality was justified using the Youden's index. The screening was conducted on the first day of admission. Patients were prospectively followed-up after the baseline assessment. Three followed-up periods, namely 14 days, 90 days, and 180 days were analyzed.
RESULTS: A total of 21,596 patients were screened. AUCs for all cut-off scores varied from 0.84 to 0.88. A total-ABCD score =2 gave the highest Youden’s index for 90 days and 180 days follow-up periods. The optimal cut-point for 14 days was score =3.
CONCLUSIONS: The TW-PCST demonstrated a good sensitivity and specificity in identification of inpatients with palliative care needs. A total-ABCD score =2 may be considered as a trigger for further referral.
Introduction: Delirium is common in palliative care. It effects up to 88% of patients with advanced cancer at end of life and has a point prevalence of 20% in the acute hospital setting across all diagnoses. It is under diagnosed and not optimally treated. “Months of the Year Backwards” (MOTYB) is an ideal screening tool for delirium with a sensitivity of 83.8%. It is brief to perform and carries low burden for patients. The aim of this study is to investigate the use of MOTYB as a screening tool for delirium in palliative care patients in the acute hospital setting.
Methods: All patients who were referred to the hospital palliative care team in September 2016 were screened.
Results: Forty five patients were screened using MOTYB. Fifteen patients (33%) screened positive for delirium.
Conclusion: MOTYB is a simple screening tool that was easily integrated into practice in a hospital service. It has the potential to identify missed cases of delirium and therefore improve management and ultimately patient outcomes.
BACKGROUND: Population ageing will lead to more deaths with an uncertain trajectory. Identifying patients at risk of dying could facilitate more effective care planning.
AIM: To determine whether screening for likely death within 12 months is more effective using screening tools or intuition.
DESIGN: Randomised controlled trial of screening tools (Surprise Question plus the Supportive and Palliative Care Indicators Tool for Surprise Question positive patients) to predict those at risk of death at 12 months compared with unguided intuition (clinical trials registry: ACTRN12613000266763).
SETTING/PARTICIPANTS: Australian general practice. A total of 30 general practitioners (screening tool = 12, intuition = 18) screened all patients ( n = 4365) aged =70 years seen at least once in the last 2 years.
RESULTS: There were 142 deaths (screening tool = 3.1%, intuition = 3.3%; p = 0.79). General practitioners identified more at risk of dying using Surprise Question (11.8%) than intuition (5.4%; p = 0.01), but no difference with Surprise Question positive then Supportive and Palliative Care Indicators Tool (5.1%; p = 0.87). Surprise Question positive predicted more deaths (53.2%, intuition = 33.7%; p = 0.001), but Surprise Question positive/Supportive and Palliative Care Indicators Tool predictions were similar (5.1%; p = 0.87 vs intuition). There was no difference in proportions correctly predicted to die (Surprise Question = 1.6%, intuition = 1.1%; p = 0.156 and Surprise Question positive/Supportive and Palliative Care Indicators Tool = 1.1%; p = 0.86 vs intuition). Screening tool had higher sensitivity and lower specificity than intuition, but no difference in positive or negative predictive value.
CONCLUSION: Screening tool was better at predicting actual death than intuition, but with a higher false positive rate. Both were similarly effective at screening the whole cohort for death. Screening for possible death is not the best option for initiating end-of-life planning: recognising increased burden of illness might be a better trigger.
INTRODUCTION: Bereavement is one of the most common and stressful life experiences one can endure. Typical grief reactions follow a course of recovery in which individuals come to terms with the loss and resume functioning within weeks to months. However, for some, grief remains indefinitely distressing. Complicated Grief (CG) refers to significant chronic impairment that stems from bereavement. Military service members experience myriad factors that likely increase their risk for developing CG. Such factors include unique bonds between service members, exposure to constant and extreme levels of stress, multiple losses, separation from family and loved ones, witnessing/learning about sudden violent and traumatic deaths, and handling human remains. The aim of this project was to explore the practicality and efficiency of screening for CG within a busy military mental health clinic, and also explore relationships between contextual variables related to a death that might be associated with screening positive for CG.
MATERIALS AND METHODS: As part of a clinical needs assessment, patients from a single mental health clinic at Naval Medical Center San Diego completed a brief grief survey that asked if they experienced a death of a person close to them, collected metrics related to losses they have experienced and included validated screeners for CG (The Brief Grief Questionnaire [BGQ] and the Inventory for Complicated Grief [ICG]). No data concerning gender, age, marital status, socioeconomic status, diagnosis, or purpose of visit (i.e., initial or follow-up visit) were collected. Institutional review board approval was obtained.
RESULTS: In our sample of service members presenting to an adult outpatient military mental health clinic, 43.5% reported having experienced a loss that still impacts them. Of that group, 61.7% screened positive on the BGQ, 59.2% screened positive on the ICG using a cutoff of 25, and 46.1% screened positive on the ICG using the cutoff of 30. These findings suggest that military service members seeking mental health treatment who endorsed experiencing a loss are at high risk for experiencing persisting, impairing grief. Additionally, patients who either lost a fellow service member and/or experienced loss while on deployment reported significantly higher scores on the BGQ or ICG than if they did not report those factors. Furthermore, correlations between total number of losses and ICG scores suggest that service members who experienced multiple losses may be more susceptible to CG symptoms.
CONCLUSION: The findings from this preliminary investigation suggest that many service members receiving care in military mental health care are experiencing grief-related symptoms and distress, and a brief screen for grief can help capture many of those with grief related impairment. Research shows that CG needs to be directly targeted to treat its symptoms and associated impairment. We recommend that military mental health clinics consider adding some type of grief screener to their standard intake as well as making providers aware of the importance of monitoring potential grief reactions in their patients.
There is a need to delineate best practices for referring, assessing, and retaining students suspected of posttraumatic stress (PTS) and maladaptive grief (MG) in school-based treatment. Evidence-based risk-screening procedures should accurately include students who are appropriate for group treatment and exclude students who do not require treatment or who are better served by other forms of intervention and support. We described and evaluated the sequence of steps used to screen 7th- and 8th-grade students (N = 89) referred by school staff as candidates for an open trial of group-based Trauma and Grief Component Therapy for Adolescents (TGCTA; Saltzman et al., in press). We used t tests to compare included versus excluded students on PTS symptom and MG reaction scores (University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index; Grief Screening Scale) during the group screen, individual interview, and treatment-implementation phases. Logistic regressions tested the incremental utility of including measures of both trauma exposure and related emotional and conduct problems (Strengths and Difficulties Questionnaire) in the screening battery. Results suggest that the group screen helped to detect mental health needs and that the individual interview further identified students with PTS and emotional problems. Conduct problems and trauma exposure predicted attrition among students who qualified for treatment. MG incrementally predicted students who advanced from the group screening to the individual interview, and trauma exposure incrementally predicted attrition from treatment. Findings yield implications for improving research and practice, including procedures for enhancing school-based referral, screening, assessment, and selection procedures.