Tackling the challenges of treating pediatric mental health in emergency settings

Youth in America over the last decade have experienced mental and behavioral health issues at alarming rates. Up to one in five children ages 3 to 17 in the U.S. have a mental, emotional, developmental, or behavioral disorder. The growing crisis requires innovative strategies to serve children in the setting where they often first seek care: emergency departments (EDs).

But gaps in ED care persists. According to data from the National Pediatric Readiness Project, in 2013-2014, only 44% of EDs had a pediatric-specific mental health policy in place.

The EMSC Program is tackling the challenges of improving pediatric mental health in emergency settings through several programs and initiatives. In honor of Children’s Mental Health Awareness Week May 6-13, below, we highlight the program’s cross-cutting efforts.

“The pediatric mental health crisis is complex and therefore requires complex solutions,” says Mohsen Saidinejad, MD, MS, MBA, a member of the EMSC Innovation and Improvement Center’s executive team and an ED physician with a focus on mental health. “From developing a research agenda to translation of knowledge into the communities of practice, the EMSC Program is taking a multifaceted approach to address the challenge and move the needle for children in crisis.”

Clinical resources

Pediatric Education and Advocacy Kits (PEAKs) are collections of best-in-class educational resources on a particular clinical topic for clinicians across prehospital and hospital emergency settings. Each PEAK goes through a comprehensive vetting process by national experts and includes multimodal resources ranging from learning modules to podcasts. The cornerstones of each PEAK are practice guidelines and care algorithms, which are developed through an international collaboration with Canada’s Translating Emergency Knowledge for Kids. All resources are free and open access. Access PEAK: Agitation and PEAK: Suicide here.

Quality Improvement (QI) Collaboratives

QI Collaboratives are forums that empower teams to rapidly translate evidence into changes in practice. Through the collaborative model, teams simultaneously learn about topics in pediatric emergency care and quality improvement science, leveraging both to improve outcomes for children in their community.

Pediatric Readiness QI Collaborative

A new collaborative has opened its registration period for ED-based teams. The 18-month forum will focus on four areas – one of which will be pediatric suicidality. This is the second cohort of the collaborative, which first took place in 2018-2020. Learn more, register, or join an upcoming webinar about the collaborative here. Registration closes June 15.

ED STOP Suicide QI Collaborative

The ED Screening and Treatment Options for Pediatric (STOP) Suicide QI Collaborative launched earlier this year with 84 teams representing 335 participants. The collaborative is focused on four areas of caring for pediatric patients with acute suicidality: screening, mental health assessment, ED-based interventions, and discharge and safety planning. Learn about the collaborative and its teams through a new infographic.

Connecting ED and primary care resources

In September 2022, the EIIC received supplemental funding to collaborate with federally funded Pediatric Mental Health Care Access (PMHCA) programs, which are working to bring behavioral health consultation, training, and support to pediatric primary care and other providers across the country. This PMHCA expansion award allows EIIC to cultivate relationships between the nation’s EDs and primary care providers through the development of a technical assistance toolkit. PMHCA awardees collaborating on the project were selected based on participation criteria and include Michigan, Washington, Delaware, Virginia, Louisiana, Oklahoma, and Tennessee. The group is currently also taking part in the ED STOP Suicide QI Collaborative.

Localized resources

The EMSC Program includes 57 State Partnership Programs and nine regional groups. These individual and regional programs work to improve emergency care at the state level, leveraging and building on national resources and research to meet the needs of their unique communities.

New England EMSC is made up of six State Partnership Programs (Connecticut, New Hampshire, Massachusetts, Maine, Rhode Island, and Vermont) with a mission to improve pediatric readiness throughout the region. The New England consortium launched a toolkit last year with three key resources:

1. An Activities Resource Packet, which covers self-care activities for patients and caregivers, including breathing, relaxing, mindfulness, and gratitude practices.
2. A Behavioral Health Training video series, which covers topics from common triggers to psychiatric medications.
3. A Comprehensive Care Bundle for providers, with a variety of resources and tools ranging from an intake form to a handoff tool.

Access the toolkit here.

Advancing the research base

A major goal of the EMSC Program is to bring scientific evidence, developed through high-quality research, to the patient bedside – primarily through the Pediatric Emergency Care Applied Research Network (PECARN).

Key recent studies out of PECARN on mental health include:

• Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments (2023)
• Understanding adolescent responses to differently worded suicide attempt questions: results from a large US pediatric sample (2022)
• Association of Physical Activity, Sports, and Screen Time With Adolescent Behaviors in Youth Who Visit the Pediatric Emergency Department (2022)

This evidence helps inform the EMSC Program’s resources and offerings—and propels the pediatric emergency field forward across the board.

“EMSC and PECARN are advancing high-quality research in several unique ways,” adds Saidinejad. “We engage clinicians in general and low-resourced EDs, where most acutely ill and injured children present, in design and implementation of research. We also create a collaborative research environment, allowing for process development and information sharing. Finally, we focus on high-priority areas of mental health research – including suicide and agitation, with an emphasis on health equity, access to care, and outcomes.”

Learn more about the EMSC Program here.