Pediatric Emergency Mental Health and Service Provider Experiences

Pediatric emergency mental health and the experiences of service providers

Abstract

Background

In the United States, an estimated 1 in 5 children under the age of 18, will experience or develop an ongoing serious mental health disorder. Despite this number only 20% of that population receives mental health treatment (National Institute of Mental Health, 2010, Office of the Surgeon General, 2001). Literature additionally theorizes that the utilization of emergency mental health care may be the result of a failing outpatient mental health system, and that the emergency department (ED) may serve as a fail-safe, and the primary entry point of children into the mental health system (Lynch, et al. 2015, Sills & Bland, 2002).

The current literature fails to gain significant understanding of the role of these services and interventions, their perceived effectiveness by providers implementing them, strengths and barriers to emergency approaches, and the perceived impact on patients in the mental health system for youth (Brown, 2005, Brown & Schubert, 2010, Lee & Korczak, 2010). As a result, questions remain unanswered regarding the overall environment, process of emergency clinical interventions, their effectiveness and the future role of those interventions.

The objective of this pilot study was to understand the professional world of those working with this population. Through qualitative, in-depth interviews the research question asked, “What are the experiences of mental health service providers working in pediatric emergency mental health environments?”

Methods:

A qualitative, constructivist approach and grounded theoretical research methodology was used to describe, understand, and theorize the experiences of individuals working in systems providing services to children requiring emergency mental health interventions. The analysis of data provided the themes and ultimately the needed theoretical definitions and results desired to fully describe the data collected from 20 service providers selected through a snowball sampling procedure. The population of service providers interviewed, represented a diverse group of professions (i.e. nursing, social work, counseling, psychiatry). Data were transcribed, coded using an initial open coding approach followed by axial coding, and analyzed utilizing Atlas.ti data management software resulting in various themes. To increase the level of trustworthiness of the research, triangulation, member checking and peer review methods were utilized.

Results:

Themes developed from the data included ethical dilemmas related to the inability to provide patients with an obtainable continuity of care, ongoing emotional toll on clinicians, and an observed increase of the emergency department as a catch-all for pediatric mental health care. In summary, these themes coalesce to provide an understanding of emergency mental health services for children that informs direct practice, but also directly relates to the role of social workers in advocating for both policy-related changes as well as the re-examination of the role and capabilities of community mental health systems for children.

 Conclusions and Implications:

 The results of this pilot study suggest that the social work profession has multiple roles in both improving the implementation and continuity of care for children in emergency mental health settings, and in providing advocacy for  children and the resulting policy interventions necessary.