Characteristics Associated With Presence of Pediatric Mental Health Care Policies in Emergency Departments

Abstract

Objectives:The majority of US children do not have access to an emergency department (ED) with a pediatric mental health care policy in place. Our objective was to understand factors associated with whether US EDs have a pediatric mental health care policy. Methods:We analyzed data from the National Pediatric Readiness Project, a nationally representative cross-sectional survey of US EDs. Nurse managers reported whether their hospitals had a policy to care for children with social/mental health concerns (n = 3612). We calculated prevalence estimates, prevalence ratios (PRs), and confidence intervals (CIs) for regional and ED characteristics (eg, rurality and types of personnel) by whether EDs had a pediatric mental health care policy.Results: Overall, 46.2% (n = 1668/3612) of EDs had a pediatric mental health care policy. Emergency departments located in remote areas were 60% less likely to have such a policy compared with EDs in urban areas (PR, 0.4; CI, 0.3-0.5). Emergency department characteristics associated with having a pediatric mental health care policy included having a policy to transfer children with social/mental health concerns (PR, 5.4; CI, 4.7-6.2), having a policy to address maltreatment (PR, 3.4; CI, 2.6-4.4), and having nurse and physician pediatric emergency care coordinators (PR, 1.6; CI, 1.5-1.8).Conclusions: Lower prevalence of pediatric mental health policies in rural EDs is concerning considering EDs are often the first point of contact for pediatric patients. This work highlights the importance of pediatric emergency care coordinators in fostering ED capacity to meet children's mental health needs.

Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020

“…Many mental disorders commence in childhood, and mental health concerns in these age groups might be exacerbated by stress related to the pandemic and abrupt disruptions to daily life associated with mitigation efforts, including anxiety about illness, social isolation, and interrupted connectedness to school ( 5 ). The majority of EDs lack adequate capacity to treat pediatric mental health concerns ( 6 ), potentially increasing demand on systems already stressed by the COVID-19 pandemic. These findings demonstrate continued need for mental health care for children during the pandemic and highlight the importance of expanding mental health services, such as telemental health and technology-based solutions (e.g., mobile mental health applications) ( 5 , 7 ).…”

Mental Health Emergency Department Visits by Children Before and During the COVID-19 Pandemic

“…resources, policies, and staff training to manage pediatric mental health needs. 20 The pandemic has fueled acceleration of the pediatric mental health crisis, and opportunities to strengthen mental health infrastructure must be explored. Increasing the availability of acute mental health services for children, such as psychiatric urgent care centers and crisis behavioral health teams, may help to reduce pediatric mental health ED visits.…”

Characteristics of children boarding in emergency departments for mental health conditions in a rural state

“…Large increases in pediatric presentations for acute MH conditions during the COVID‐19 pandemic and lack of infrastructure to address these concerns have resulted in high rates of ED boarding 4,5 . Prior studies of ED boarding by pediatric patients with MH conditions are primarily focused on urban hospitals where there is more infrastructure for MH care 6,7 . The landscape of ED boarding for patient with MH conditions, notably during the COVID‐19 pandemic, in rural areas is less well understood.…”

“…4,5 Prior studies of ED boarding by pediatric patients with MH conditions are primarily focused on urban hospitals where there is more infrastructure for MH care. 6,7 The landscape of ED boarding for patient with MH conditions, notably during the COVID-19 pandemic, in rural areas is less well understood. Our objective was to assess characteristics of children boarding in EDs for MH conditions in a rural state.…”