Acute Crisis Care for Patients with Mental Health Crises: Initial Assessment of an Innovative Prehospital Alternative Destination Program in North Carolina

Creed, Jamie O.; Cyr, Julianne; Owino, Hillary; Box, Shannen E.; Ives-Rublee, Mia; Sheitman, Brian; Steiner, Beat; Williams, Jeffrey M.; Bachman, Michael W; Cabañas, José G.; Myers, Joseph B.; Glickman, Seth W.

doi:10.1080/10903127.2018.1428840

Cited by 35 publications

(38 citation statements)

References 6 publications

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“…These are patients with mental health issues and those affected by drugs and alcohol (Kleissl-Muir et al , 2018; Nikathil et al , 2017). Both presentations place a substantial burden on EDs, where workers do not always feel equipped to deal with these patients (Creed et al , 2018; Thomas et al , 2021). Furthermore, the ED is not deemed an appropriate environment for many of these patients.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the ED is not deemed an appropriate environment for many of these patients. They often wait for long periods of time in a highly stimulating environment, only to find that there are no suitable care pathways available to them (Creed et al , 2018; Thomas et al , 2021). In this context, we need to consider that for those with a mental health disorder, there is already a risk of stigmatisation, and these illnesses are associated with poorer health-care access and social marginalisation (Perry et al , 2020).…”

Section: Introductionmentioning

confidence: 99%

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Violence against emergency healthcare workers: different perpetrators, different approaches

Spelten

Vuuren

O’Meara

et al. 2022

JACPR

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Purpose This study aims to investigate whether emergency health-care workers distinguish between different categories of perpetrators of violence and how they respond to different types of perpetrator profiles. Design/methodology/approach Five focus groups with emergency health-care workers were held in Canada. The participants were asked whether they identified different groups of perpetrators of violence and how that impacted their approach. The focus group responses were transcribed verbatim and analysed thematically using a phenomenological approach. Findings Participants consistently identified five groups of perpetrators and tailored their approach on their assessment of the type of perpetrator involved. The five categories are: violence or aggressive behaviour from family members or bystander and violence related to; underlying mental health/illness issues; underlying physical health issues; addiction and substance use; and repeat visitors/offenders. Violence with an underlying (mental) health cause was handled professionally and compassionately by the health-care workers, while less patience and understanding was afforded in those instances where violence was associated with (recreational) alcohol or illicit substance use. Originality/value Emergency health-care workers can consistently distinguish between types of perpetrators of violence and aggression, which they then use as one factor in the clinical and situational assessments that inform their overall approach to the management incidents. This conclusion supports the need to move the focus away from the worker to the perpetrator and to an organisational rather than individual approach to help minimise violence against emergency health-care workers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Violence against emergency healthcare workers: different perpetrators, different approaches

Spelten

Vuuren

O’Meara

et al. 2022

JACPR

View full text Add to dashboard Cite

show abstract

“…– Community-based follow-up care: social work [ 55 120 121 122 ], home care nursing [ 56 121 ], diabetes clinics [ 79 80 ], falls prevention teams [ 75 77 ] and mental health facilities [ 57 59 123 124 125 ]…”

Section: Resultsmentioning

confidence: 99%

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

et al. 2022

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Introduction: Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. Methods: A study was conducted following Arksey and O’Malley’s method for scoping reviews, using Valentijn’s Rainbow Model of Integrated Care as an organizing framework. Qualitative content analysis was done on clinical, professional, organizational, system, functional and normative aspects of integration. Common patterns, challenges and gaps were documented. Results: After literature search and screening, 137 documents with 108 unique programs were analysed. Paramedics bridge reactive and preventative care for a spectrum of population needs through partnerships with hospitals, social services, primary care and public health. Programs encountered challenges with role delineation, segregated organizations, regulation and tensions in professional norms. Discussion: Five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value. Conclusion: Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.

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“…Even though a higher proportion of pediatric EMS calls are for low-acuity complaints than adult EMS calls, children have been excluded from the vast majority of community paramedicine programs 39 and other local initiatives that triage specific EMS calls to sites of care other than the ED. [40][41][42] A recent study found that 19% of all pediatric 911 calls in the US end with a caregiver refusal of transport. 43 This is substantially higher than the level of patient refusals for adults.…”

Section: Discussionmentioning

confidence: 99%

Caregiver Perceptions Regarding Alternative Emergency Medical Services Dispositions for Children: A Cross-Sectional Survey Analysis

Ward

Gougelet

Pearman

et al. 2022

WestJEM

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Introduction: Emergency medical services (EMS) systems have developed alternative disposition processes for patients (including leaving the patient at the scene, using taxis, and transporting to clinics) vs taking patients directly to an emergency department (ED). Studies show that patients favorably support these alternative options but have not included the perspectives of caregivers of children. Our objective was to describe caregivers’ views about these alternative disposition processes and analyze whether caregiver support is associated with sociodemographic factors. Methods: We surveyed a convenience sample of caregivers in a pediatric ED. We asked caregivers 15 questions based on a previously validated survey. We then conducted logistic regressions to determine whether sociodemographic factors were associated with levels of support. Results: We enrolled 241 caregivers. The median age of their children was five years. The majority of respondents were non-Hispanic Black (57%) and had public insurance (65%). We found that a majority of respondents supported all alternative EMS disposition options. The overall level of agreement for survey questions ranged from 51-93%. We grouped questions by theme: non-transport; alternative destinations; communication with EMS physician; communication with primary care physician and sharing records; restricted EMS role; and shared decision-making. Regression analyses for each theme found that race/ethnicity, public insurance, and patient age were not significantly associated with the level of support. Conclusion: Most caregivers were supportive of alternative EMS disposition options for children with low-acuity complaints. Support did not vary significantly by respondent race/ethnicity, public insurance status, or patient age.

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Acute Crisis Care for Patients with Mental Health Crises: Initial Assessment of an Innovative Prehospital Alternative Destination Program in North Carolina

Cited by 35 publications

References 6 publications

Violence against emergency healthcare workers: different perpetrators, different approaches

Violence against emergency healthcare workers: different perpetrators, different approaches

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

Caregiver Perceptions Regarding Alternative Emergency Medical Services Dispositions for Children: A Cross-Sectional Survey Analysis

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