Understanding Provider Perspectives on Emergency Mobile Psychiatric Services for Youth: Policy and Practice Implications

Background and Purpose: While quantitative analyses address the effect of Emergency Mobile Psychiatric Services (EMPS) use on Emergency Department (ED) use and identify barriers and facilitators to reducing ED use, they fail to convey nuances important to understanding how and why these findings emerge. In this component of the study, we used qualitative methods to enhance our understanding of the relationship between EMPS and ED use. Providers were asked about program strengths, challenges, the extent to which EMPS providers connect families to ongoing care, as well as how EMPS can be improved. 

Methods: Between April and November 2017, focus groups were conducted with providers at seven of the nine EMPS agencies that serve the state of Connecticut. In total, 33 providers were interviewed (three to six per agency).  Average age was 33.8 years (ranged from a mean of 30.2 to 41.0 per agency). The majority (93.9%) were female and 60.6% were White. Half the participants (51.7%) were clinicians, 44.8% were supervisors or administrators, and one was a program assistant.  All but one of the providers had an MSW. Of the 29 who indicated their duration of EMPS employment, 69.7% had worked for two or more years whereas the remainder had worked between six months and two years. Those who had worked less than six months were excluded from the study.

A semi-structured interview guide was used to elicit the providers’ description of the EMPS program’s goals and methods, and the service, child, and family-related factors that enhance or impede EMPS. The focus groups were transcribed and coded thematically, guided by the principles of phenomenology.

Results: The data indicate that EMPS providers follow best practices with children in crisis and have a high threshold for ED referral. Providers indicated that family support greatly influences their ability to help clients.

Providers noted that they face resistance at all levels of their intervention. Some referring agencies still call 911 rather than 211, which EMPS addresses through community outreach and psychoeducation. Furthermore, private insurance often does not cover behavioral healthcare and there is a dearth of accessible treatment options for clients with severe disorders. Sometimes EMPS is used as a holding environment for the severely disordered who are unable to access treatment, which is beyond the scope of their charge. 

Conclusion and Implications: Implementing a program such as EMPS is a sea change. Getting families and referring agencies to use EMPS rather than the ED for youth in psychiatric crisis requires skilled practitioners to work with the children, youth, and their families as well as to collaborate with the EDs and hospitals, other service providers, and referring agencies. Some obstacles faced by EMPS require policy-level change such as encouraging private insurance to cover behavioral health options and establishing more accessible treatment options for those with more severe disorders. As such, EMPS social workers must bridge micro level practice and macro level advocacy and policy work, a combination that is relatively rare in social work, but indispensable for innovative practices such as EMPS.