The Role of the Social Worker in Mental Health Assessments in Emergency Departments and How PMHCAs Can Engage

By Angela Nguyen

Emergency entrance

Emergency Department (ED) social workers are Licensed Mental Health specialists who often conduct many different specialty assessments in the ED. They are experts in conducting mental health assessments in all areas of the child’s life using evidence-based tools that evaluate risk and protective factors (bio-psycho-social assessments), safety planning, and making recommendations within the interdisciplinary team to create and then execute a plan for the child’s disposition.

Often, the difference between a child boarding in the ED and going home is the access to the appropriate level of support upon discharge. A strong discharge plan includes an appointment with a provider [primary care physician (PCP), therapist, partial hospitalization program (PHP)/ intensive outpatient program (IOP), psychiatrist] within 72 hours of discharge; access to a provider to either start or adjust medications if needed; referrals to Mental Health resources for on-going care and coordination with schools.

Trips to the ED for mental health needs are seen as a last resort, and unlike other specialties (neurology, orthopedics, cardiology, etc.), coming to an emergency department does not often result in a referral to a specialist for outpatient follow-up care. These trips to the ED are emotionally and financially stressful for patients and their families, resulting in families not having a strong understanding of the next steps to best support their child and navigate the Behavioral Health system.

Lastly, we know coming to the ED for a mental health crisis is very stressful for families. Often, EDs don’t have the ability to directly schedule appointments for families and often provide a list of resources. One gap in the discharge planning process is the ability to coordinate with schools and/or families upon discharge to support the family to ensure the family can connect with resources. This follow-up support is extremely important in preventing patients from needing to come back into the ED.

One main way Pediatric Mental Health Care Access (PMHCA) programs can collaborate with ED social workers is through disposition planning and helping to create a common language between EDs and outpatient providers.

A strong relationship between ED social workers and PMHCAs can expedite the discharge planning process through a single point of contact to communicate with a group of PCPs and/or schools. This ability to collaborate with a trusted and reliable program during the child’s transition from the ED back to the community can have a pivotal part in decreasing the overall length of time the families are in crisis and preventing readmissions to the ED.

To learn more about engaging with emergency departments, check out the PMHCA Technical Assistance Toolkit.

About the author:

angela ngyuen

Angela Nguyen, LCSW, has more than 15 years of experience in Mental Health/Medical healthcare settings. Her areas of specialty include anxiety, relationship difficulties, chronic illness, caregiver/parenting support, life transitions, and burnout/stress related to working in helping professions. Her clinical focus is children, adolescents, and adults.