Resources and Results

Those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.

• CYSHCN account for >15% of all US children
  • Over 20% of CYSHCN rely on EDs for services
  • 3 million CYSHCN have complex medical conditions
• Families often face higher medical costs, inadequate health insurance coverage, and increased stress on families
• Viral illnesses may pose a greater risk to CYSHCN due to underlying comorbidities
• Public health crises may cause the postponement of treatments due to exposure risk, clinic closures, or access, which can result in clinical deterioration

Children and youth with mental health, substance abuse, or other behavioral health issues requiring emergency care or other appropriate interventions.

• Pediatric ED visits remained stable, yet visits for all mental health disorders increased by 60% from 2007 to 2016
• ED visits increased for:
  • Intentional self-harm - 329%
  • Substance use disorders - 159%
• Visits to low-volume, rural EDs increased by 12%
  • Suicide rates 2X higher in rural communities compared to urban communities
• Variability in pediatric readiness of EDs

Prior to the COVID pandemic, children accounted for 20-22% of all ED visits. Yet, the greatest decreases in ED visits since March 2020 are among those less than 14 years of age (over 70% decrease in visits). This effect has the potential to further marginalize children, a relative minority within the larger ED patient population. While the impact of these public health crises is experienced broadly by all, rural communities, and certain vulnerable populations, including children face a disproportionate toll.

Social distancing, school closures, and socioeconomic setbacks have the potential to exacerbate physiologic and psychologic stressors. These environments have been associated with increased rates of mental health issues, suicide, substance abuse, and child maltreatment. In addition to school closures, children requiring regular medications and healthcare appointments, namely children and youth with special healthcare needs (CYSHCN), may suffer gaps in care and treatments due to clinic closures and decreased availability of care provision. Thus, within the pediatric emergency care space, CYSHCN and children with behavioral health emergencies (CBHE) are at heightened risk.

While emergency department (ED) visits have declined by more than 40% for general EDs and 65% for pediatric EDs since the onset of the COVID pandemic in the United States (US), a greater proportion of patients are presenting with high acuity illnesses.

It has been suggested that this decline in patient visits for serious conditions could result in complications or death.

• Children less than 14 years of age account for the greatest decrease in ED visits since March 2020 (over 70% decrease in visits)
• Social distancing, school closures, and socioeconomic setbacks are associated with increased mental health issues, suicide, substance abuse, and child maltreatment
• Children requiring regular health services and medications may suffer gaps in care and treatments due to clinic closures or decreased availability