Friday, January 18, 2019: 1:45 PM-3:15 PM
Golden Gate 5, Lobby Level (Hilton San Francisco)
Cluster: Mental Health (MH)
Michael Fendrich, PhD, University of Connecticut
Jeffrey Vanderploeg, Ph.D., Child Health & Development Institute of Connecticut, Inc.
Background and Purpose: Pediatric behavioral health visits to emergency departments have skyrocketed nationally in recent years. For many youth, emergency departments (EDs) are less than optimal treatment settings. EDs often lack providers with the specialized training necessary to address child mental health needs, and are often not equipped to provide the follow-up care and connections needed to adequately address a child's behavioral health problems. Behavioral health treatment in the ED is also expensive. With this in mind, the state of Connecticut developed a community-based, mobile intervention service for addressing emergency behavioral health needs of youth. The Emergency Mobile Psychiatric Service (EMPS) provides community-based services to address acute behavioral health needs, with the aim of providing timely, community based intervention by mental health professionals. This symposium explores research which was established to evaluate the impact of EMPS on three main questions: 1) How effective was the EMPS in preventing youth with behavioral health diagnoses from being admitted to EDs compared to a comparison group of non-EMPS youth with behavioral health ED (BHED) use? 2) Among youth receiving EMPS services, what were the variables most associated with subsequent ED service use? 3) What were major barriers and facilitators of EMPS success? Methods: The first paper uses propensity score matching to assess the relative risk for subsequent ED use for EMPS users and a comparison group of youth who received behavioral health services in the ED. The second paper assesses the relative importance of prior service use, demographic characteristics, child functioning, and EMPS service episode variables on the risk of subsequent ED use among youth receiving EMPS services, using tree regression procedures (CR&T). The third paper discusses the results of qualitative focus group interviews with service providers at each of the seven EMPS sites throughout the state. Our discussant addresses the implications of the findings for the delivery of mental health services targeted to youth and families in the community. Results: Relative to the propensity-matched comparison group, the first paper found that EMPS youth had significantly reduced risk of subsequent ED visits. The second paper suggested that service use history variables were the most important predictors of ED visits for EMPS youth; specifically, youth with a history of multiple ED visits before the EMPS visit and more extensive use of behavioral health services were significantly more likely to use ED services. In the qualitative study, providers identified family isolation, problems with referral processes and systems issues (such lack of reimbursement by insurance carriers) as barriers to EMPS use. Conclusions/Implications: In addition to expanding EMPS services, increasing public awareness of mental health service alternatives may prevent unnecessary ED use. EMPS services may need to tailor their approach with particularly high-risk youth – using the findings of this study as guidance. This will require the development of screening tools and more extensive and targeted training of social workers and other front-line mental health professionals. The findings presented here have national implications for mental health services and social work training.
* noted as presenting author
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