The Use of Telepsychiatry to Provide Cost-Efficient Care During Pediatric Mental Health Emergencies

Thomas, John F.; Novins, Douglas K.; Hosokawa, Patrick; Olson, Christina A.; Hunter, Dru; Brent, Alison; Frunzi, Gerard; Libby, Anne M.

doi:10.1176/appi.ps.201700140

Cited by 76 publications

(116 citation statements)

References 23 publications

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“…Note that non-VHA transfers are not included on this figure. The authors would like to acknowledge Morgan Swanson, BS for her assistance with preparation of this figure psychiatric resources across geographic areas, and these networks have even provided care in emergency departments [40,[45][46][47][48][49][50][51]. Providing detailed psychiatric evaluation, treatment recommendations, and disposition guidance could be one important service that could improve cost-effective access to mental health professionals, especially for rural veterans.…”

Section: Discussionmentioning

confidence: 99%

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Mohr

Ward

et al. 2020

BMC Health Serv Res

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Background: Inter-facility transfer is an important strategy for improving access to specialized health services, but transfers are complicated by over-triage, under-triage, travel burdens, and costs. The purpose of this study is to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. Methods: This observational cohort study included all patients treated in VHA EDs between 2012 and 2014 who were transferred to another VHA hospital. Potentially avoidable transfers were defined as patients who were either discharged from the receiving ED or admitted to the receiving hospital for ≤1 day without having an invasive procedure performed. We conducted facility-and diagnosis-level analyses to identify subgroups of patients for whom potentially avoidable transfers had increased prevalence. Results: Of 6,173,189 ED visits during the 3-year study period, 18,852 (0.3%) were transferred from one VHA ED to another VHA facility. Rural residents were transferred three times as often as urban residents (0.6% vs. 0.2%, p < 0.001), and 22.8% of all VHA-to-VHA transfers were potentially avoidable transfers. The 3 disease categories most commonly associated with inter-facility transfer were mental health (34%), cardiac (12%), and digestive diagnoses (9%). Conclusions: VHA inter-facility transfer is commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.

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Section: Discussionmentioning

confidence: 99%

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Mohr

Ward

et al. 2020

BMC Health Serv Res

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“…The final sample comprised of 19 articles included in this review and provides outcome evidence in the following four domains: alternative models [21,26,27,29,30]; interventions applied to Crisis [22,[31][32][33]; telepsychiatry and mobile applications applied to mental health crisis [35,38,39,41]; and experience and satisfaction with mental health crisis provision [25,28,34,36,37,40].…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…The 19 studies included in this review came from 5 different countries; 8 studies came from the UK [21,22,[25][26][27][28][29][30], 5 from the US [31][32][33][34][35], 3 from Australia [36][37][38], 2 from Canada [39,40] and 1 from Denmark [41]. Eight studies utilised a qualitative methodology [25,28,29,34,[36][37][38]40] and two studies were based on a qualitative case-study approach [22,33].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eight studies utilised a qualitative methodology [25,28,29,34,[36][37][38]40] and two studies were based on a qualitative case-study approach [22,33]. In contrast, three studies followed a quantitative descriptive approach [30,35,39], while one study had a mixed-methods design [26]. Two studies followed an RCT design [27,31] and two studies were non-randomised with their methodological approach [21,32].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The US and Canadian study reported high satisfaction with the use of telepsychiatry [35,39]. Telepsychiatry is perceived as CYP friendly with a high degree of CYP/Parental acceptability and improved service experience [39].…”

Section: Satisfaction With Tmhmentioning

confidence: 99%

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Experiences and satisfaction of children, young people and their parents with alternative mental health models to inpatient settings: a systematic review

Vusio

Thompson

Birchwood

et al. 2019

Eur Child Adolesc Psychiatry

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Community-based mental health services for children and young people (CYP) can offer alternatives to inpatient settings and treat CYP in less restrictive environments. However, there has been limited implementation of such alternative models, and their efficacy is still inconclusive. Notably, little is known of the experiences of CYP and their parents with these alternative models and their level of satisfaction with the care provided. Therefore, the main aim of this review was to understand those experiences of the accessibility of alternative models to inpatient care, as well as overall CYP/parental satisfaction. A searching strategy of peer-reviewed articles was conducted from January 1990 to December 2018, with updated searches conducted in June 2019. The initial search resulted in 495 articles, of which 19 were included in this review. A narrative synthesis grouped the studies according to emerging themes: alternative models, tele-psychiatry and interventions applied to crisis, and experiences and satisfaction with crisis provision. The identified articles highlighted increased satisfaction in CYP with alternative models in comparison with care as usual. However, the parental experiential data identified high levels of parental burden and a range of complex emotional reactions associated with engagement with crisis services. Furthermore, we identified a number of interventions, telepsychiatric and mobile solutions that may be effective when applied to urgent and emergency care for CYP experiencing a mental health crisis. Lastly, both parental and CYP experiences highlighted a number of perceived barriers associated with help-seeking from crisis services.

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Psychiatric Boarding Trends Among Publicly Insured Youths During the COVID-19 Pandemic—The Other Pandemic

Donovan

2023

JAMA Netw Open

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Psychiatric boarding is a crucial clinical and mental health systems challenge deserving attention and discussion. In the JAMA Network Open article, Herrera et al 1 studied psychiatric boarding among publicly insured youths, ages 4 to 20 years (mean age, 13.6 years), who had been evaluated by a mobile crisis team (MCT) in Massachusetts. They compared boarding rates, boarding length of stay, disposition after boarding, and re-presentation within 30 days before and during the COVID-19 pandemic. They found that during the first 18 months of the pandemic, the odds of an MCT encounter resulting in boarding for publicly insured youths doubled, while simultaneously boarding encounters were significantly less likely to end with admission to inpatient or residential care. In addition, publicly insured youths who experienced boarding had significantly more readmissions within 30 days. This report paints a stark picture of psychiatric emergency services for publicly insured youths during the pandemic. The study population of publicly insured youths represents a vulnerable group experiencing a psychiatric crisis so severe that either inpatient or residential care is initially required, 80% of whom were youths of color. While boarding, these youths were supervised, kept in a safe environment, and may have had pharmacotherapy, but no additional treatment was available.Compared with their prepandemic counterparts, a larger percentage of these youths never received the higher level of care they required; they were eventually discharged home, and a portion of them received no additional services.Herein lies the importance of these findings. Although increases in boarding during the pandemic are well-established, 2 the Herrera et al 1 article is the first to demonstrate that compared with prepandemic, during the pandemic, publicly insured youths evaluated by a MCT who were boarding for a higher level of care were less likely ever to receive the treatment for which they were waiting. Perhaps even more importantly, while youths were stable at the time of discharge, for some, this stability was short-lived; they subsequently had more readmissions within 30-days after discharge and more repeat encounters overall. For these youths, boarding was a temporizing measure, not a definitive treatment.The failure of our mental health care system to adequately address the psychiatric needs of our children must serve as a warning that the entire system is in danger of collapse. A system that cannot care for the most vulnerable populations, those most in need of immediate treatment and those who may develop life-long psychiatric illness without treatment, is not performing its most basic and crucial role-preventing long-term disability, morbidity, and mortality. While the mental health care system had inadequate capacity long before the COVID-19 pandemic, it triggered increased psychiatric symptoms in youths and exacerbated the treatment shortages at all levels, creating a mental health care crisis that must be addressed.The problems with the men...

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The Use of Telepsychiatry to Provide Cost-Efficient Care During Pediatric Mental Health Emergencies

Cited by 76 publications

References 23 publications

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Experiences and satisfaction of children, young people and their parents with alternative mental health models to inpatient settings: a systematic review

Psychiatric Boarding Trends Among Publicly Insured Youths During the COVID-19 Pandemic—The Other Pandemic

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