Mental Health 911: Advocating for the Integration of Behavioral Health Services in Pediatric Hospital Emergency Departments
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Abstract
The COVID-19 pandemic of 2020 has led to increased awareness of mental health needs among pediatric populations. As the number of pediatric mental health emergency department visits have increased, so has the need for integrated behavioral health services in hospitals. This paper describes a standard of mental health care and the benefits of providing mental health services in pediatric hospital settings. The Trauma Mental Health Counseling Program, Hurt-2- Healing (H2H™) was developed and implemented in a Level-1 pediatric hospital and has served a total of 1,523 pediatric trauma patients and their caregivers since 2021. This program established a new hospital-based standard of mental healthcare for pediatric trauma patients and their caregivers. A questionnaire was developed to evaluate the efficacy of the Hurt-2-Healing program within domains such as openness to seeking counseling, psychoeducation, helpfulness of counseling, and ability to cope with the traumatic injury. The majority of (83%) patients/caregivers had no previous counseling experience prior to hospital admittance. Questionnaire responses indicated that after receiving mental health services, caregivers felt more aware of their children’s mental health needs and reported being more open to seeking future mental health counseling services for their child. Further, most respondents were in strong agreement that receiving mental health counseling services during the hospital stay was helpful. These results highlight the need for, and benefit of, providing a standard of care integrating behavioral health services in pediatric hospitals.
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References
2.Radhakrishnan L, Leeb RT, Bitsko RH, et al. Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic — United States, January 2019–January 2022. MMWR Morbidity and Mortality Weekly Report. 2022;71(8):319-324. doi:10.15585/mmwr.mm7108e2
3.Cushing AM, Liberman DB, Pham PK, et al. Mental health revisits at US Pediatric Emergency Departments. JAMA Pediatrics. 2023;177(2):168. doi:10.1001/jamapediatrics.2022.4885
4.Shankar LG, Habich M, Rosenman M, Arzu J, Lales G, Hoffmann JA. Mental health emergency department visits by children before and during the COVID-19 pandemic. Academic Pediatrics. 2022;22(7):1127-1132. doi:10.1016/j.acap.2022.05.022
5.Fatima, Hays, Neilson, Knight, Jatrana. Why patients attend emergency department for primary care type problems: Views of healthcare providers working in a remote community. Rural and Remote Health. 2022;22(7054). doi:10.22605/rrh7054
6.Rocovich C, Patel T. Emergency department visits: Why adults choose the emergency room over a primary care physician visit during regular office hours? World Journal of Emergency Medicine. 2012;3(2):91. doi:10.5847/wjem.j.issn.1920-8642.2012.02.002
7.Brody AM, Murphy E, Flack JM, Levy PD. Primary care in the emergency department – an untapped resource for Public Health Research and Innovation. West Indian Medical Journal. 2014. doi:10.7727/wimj.2013.332
8.Haltiwanger KA, Pines JM, Martin ML. The pediatric emergency department: a substitute for primary care? Cal J Emerg Med. 2006;7(2).
9.Vogel JA, Rising KL, Jones J, Bowden ML, Ginde AA, Havranek EP. Reasons patients choose the emergency department over primary care: A qualitative metasynthesis. Journal of General Internal Medicine. 2019;34(11):2610-2619. doi:10.1007/s11606-019-05128-x
10.Hong M, Thind A, Zaric GS, Sarma S. The impact of improved access to after-hours primary care on emergency department and Primary Care Utilization: A systematic review. Health Policy. 2020;124(8):812-818. doi:10.1016/j.healthpol.2020.05.015
11.Pereira LM, Wallace J, Brown W, Stancin T. Utilization and emergency department diversion as a result of pediatric psychology trainees integrated in Pediatric Primary and specialty clinics. Clinical Practice in Pediatric Psychology. 2021;9(1):58-67. doi:10.1037/cpp0000315
12.Rodriguez T. Current state of emergency mental health care in the US. Psychiatry Advisor. July 18, 2022. Accessed February 11, 2023. https://www.psychiatryadvisor.com/home/topics/general-psychiatry/many-areas-in-us-lack-access-to-emergency-psychiatric-and-crisis-services/.
13.Chen CY-C, Byrne E, Vélez T. Impact of the 2020 pandemic of covid-19 on families with school-aged children in the United States: Roles of Income Level and race. Journal of Family Issues. 2021;43(3):719-740. doi:10.1177/0192513x21994153
14.Shim R, Rust G. Primary care, behavioral health, and Public Health: Partners in Reducing Mental Health Stigma. American Journal of Public Health. 2013;103(5):774-776. doi:10.2105/ajph.2013.301214
15.Bambling M. Mind, body and heart: Psychotherapy and the relationship between mental and physical health. Psychotherapy in Australia . 2006;12.
16.Kwan BM, Nease DE. The state of the evidence for Integrated Behavioral Health in Primary Care. Integrated Behavioral Health in Primary Care. 2013:65-98. doi:10.1007/978-1-4614-6889-9_5
17.Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health, and cost. Health Affairs. 2008;27(3):759-769. doi:10.1377/hlthaff.27.3.759
18.Glowacki K, Whyte M, Weinstein J, et al. Exploring how to enhance care and pathways between the Emergency Department and integrated youth services for young people with mental health and substance use concerns. BMC Health Services Research. 2022;22(1). doi:10.1186/s12913-022-07990-8
19.Niedzwiecki MJ, Sharma PJ, Kanzaria HK, McConville S, Hsia RY. Factors associated with emergency department use by patients with and without mental health diagnoses. JAMA Network Open. 2018;1(6). doi:10.1001/jamanetworkopen.2018.3528
20.Ruzek JI, Young BH, Cordova MJ, Flynn BW. Integration of Disaster Mental Health Services with emergency medicine. Prehospital and Disaster Medicine. 2004;19(1):46-53. doi:10.1017/s1049023x00001473
21.Zealberg J, Santos A, Puckett JA. Comprehensive Emergency Mental Healthcare. Washington, D.C.: Beard Books; 1996.
22.Regier DA. The de facto US mental health services system. Archives of General Psychiatry. 1978;35(6):685. doi:10.1001/archpsyc.1978.01770300027002
23.North CS, Pfefferbaum B. Mental health response to community disasters. JAMA. 2013;310(5):507. doi:10.1001/jama.2013.107799
24.Bryant RA. Early intervention after trauma. Evidence Based Treatments for Trauma-Related Psychological Disorders. 2022:135-159. doi:10.1007/978-3-030-97802-0_7
25.Honig RG, Grace MC, Lindy JD, Newman CJ, Titchener JL. Assessing long-term effects of trauma: Diagnosing symptoms of avoidance and numbing. American Journal of Psychiatry. 1999;156(3):483-485. doi:10.1176/ajp.156.3.483
26.Hoffmann JA, Krass P, Rodean J, et al. Follow-up after Pediatric Mental Health Emergency visits. Pediatrics. 2023. doi:10.1542/peds.2022-057383
27.McBain RK, Kofner A, Stein BD, Cantor JH, Vogt WB, Yu H. Growth and distribution of child psychiatrists in the United States: 2007–2016. Pediatrics. 2019;144(6). doi:10.1542/peds.2019-1576
28.Schauss E, Hawes K, Roberts S, et al. Examining the incidence of acute stress in pediatric trauma patients. Trauma Surgery & Acute Care Open. 2022;7(1). doi:10.1136/tsaco-2022-000946
29.Bosquet Enlow M, Kassam-Adams N, Saxe G. The child stress disorders checklist-short form: A four-item scale of traumatic stress symptoms in children. General Hospital Psychiatry. 2010;32(3):321-327. doi:10.1016/j.genhosppsych.2010.01.009
30.Ravens-Sieberer U, Herdman M, Devine J, et al. The European Kidscreen Approach to measure quality of life and well-being in children: Development, current application, and future advances. Quality of Life Research. 2013;23(3):791-803. doi:10.1007/s11136-013-0428-3
31.Vahratian A, Blumberg SJ, Terlizzi EP, Schiller JS. Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic — United States, August 2020–February 2021. MMWR Morbidity and Mortality Weekly Report. 2021;70(13):490-494. doi:10.15585/mmwr.mm7013e2