Evaluation of an Integrated Psychology Service in a Pediatric Emergency Department and Urgent Care

Abstract

Objectives: Children visiting emergency departments (EDs) are disproportionately affected by mental health disorders. Integrated behavioral health models hold promise for improving care among ED patients. We implemented and evaluated a novel behavioral health service integrated psychology trainees in a safety net hospital's pediatric ED and urgent care.Methods: Consultations and interventions provided were identified from the service's patient registry. Patients treated by the service were matched based on age, sex, day, and month of presentation to control patients who received a brief assessment by a specialized psychiatric nurse or patients receiving comprehensive management in a psychiatric emergency service. Rates of ED return visits were obtained from local hospital records, and insurance claims were used to identify rates of psychiatric hospitalization and outpatient follow-up care. Results:The most commonly provided interventions among 71 intervention patients were assistance with connection to follow-up behavioral health treatment (65%), relaxation training (41%), and motivational interviewing (31%). These patients were matched with 142 comparison patients. There was no difference among groups in return rates within 90 days among intervention versus nurse assessment or psychiatric emergency service patients (25% vs 23% vs 13%, P = 0.14). Insurance claims data were available for 115 patients (54%): within 90 days, integrated care patients were less likely to have at least 1 outpatient claim (52% vs 78% vs 84%, P < 0.01), and there was no difference in rates of psychiatric hospital admission (18% vs 20% vs 24%, P = 0.83).Conclusions: Although this psychology-led integrated behavioral health service delivered a range of brief psychotherapeutic interventions, its impact on outpatient, inpatient, and emergency care was mixed. This lower follow-up rate among intervention patients may reflect the success of active psychological treatment in the ED, lower acuity among intervention patients, or implications of the study's safety net setting. The authors discuss this model's potential for enhancing mental health care in pediatric EDs.

Integrated care for children living with complex care needs: an evolutionary concept analysis

“…Rodgers outlines that the first step in analysing a concept is to identify surrogate terms that may be used as an alternative to the main concept [ 12 , 13 ]. Out of 23 studies, only three used the terminology ‘integrated care programme’ [ 3 , 5 , 22 ], and surrogate terms included ‘integrated service’ [ 15 – 18 ], ‘integrated method’ [ 19 ], and ‘integrated support system’ [ 19 ] (see Table 2 ). Thirteen articles referred to using a specific integrated model of care [ 3 , 15 , 17 , 18 , 21 – 29 ].…”

“…Out of 23 studies, only three used the terminology ‘integrated care programme’ [ 3 , 5 , 22 ], and surrogate terms included ‘integrated service’ [ 15 – 18 ], ‘integrated method’ [ 19 ], and ‘integrated support system’ [ 19 ] (see Table 2 ). Thirteen articles referred to using a specific integrated model of care [ 3 , 15 , 17 , 18 , 21 – 29 ]. Models of care described were chosen specifically to suit the study population and included ‘integrated behavioural model’ [ 15 , 17 ], ‘family integrated care model’ [ 24 – 26 ], ‘integrated clinic model’ [ 27 ], ‘integrated practice model’ [ 23 ], ‘integrated complex care model’ [ 3 ], ‘integrated care model’ [ 22 , 28 ], ‘Children’s Treatment Network’[ 18 ], ‘The Paediatric Perioperative Surgical Home model’ [ 21 ], and ‘collaborative practice model’ [ 29 ].…”

“…Thirteen articles referred to using a specific integrated model of care [ 3 , 15 , 17 , 18 , 21 – 29 ]. Models of care described were chosen specifically to suit the study population and included ‘integrated behavioural model’ [ 15 , 17 ], ‘family integrated care model’ [ 24 – 26 ], ‘integrated clinic model’ [ 27 ], ‘integrated practice model’ [ 23 ], ‘integrated complex care model’ [ 3 ], ‘integrated care model’ [ 22 , 28 ], ‘Children’s Treatment Network’[ 18 ], ‘The Paediatric Perioperative Surgical Home model’ [ 21 ], and ‘collaborative practice model’ [ 29 ]. The variation in the terminology highlights how the focus of integrated care has developed and changed over time.…”

“…Patients received standard SCD treatment but were also screened for pulmonary symptoms using asthma control questionnaires, along with asthma education and written action plans provided to patients and families Horizontal Integrated clinic model 3. Casher et al [ 15 ] USA Evaluation study Patients in paediatric EDs and urgent care (3–19 yrs, n = 213) Enhanced integrated behavioural health service: doctoral-level psychology resident was integrated into the primary team to be the first point of contact for psychiatric consult questions. They reviewed patient medical records and were available for brief consultations.…”

“…Step 5: Identify implications and ideas for further development of concept a specific integrated model of care [3,15,17,18,[21][22][23][24][25][26][27][28][29]. Models of care described were chosen specifically to suit the study population and included 'integrated behavioural model' [15,17], 'family integrated care model' [24][25][26], 'integrated clinic model' [27], 'integrated practice model' [23], 'integrated complex care model' [3], 'integrated care model' [22,28], 'Children's Treatment Network' [18], 'The Paediatric Perioperative Surgical Home model' [21], and 'collaborative practice model' [29]. The variation in the terminology highlights how the focus of integrated care has developed and changed over time.…”