Reducing Inappropriate ED Use for Pediatric Behavioral Health

Two Imperatives to Improve Ambulatory Care Access

Topics: Pediatrics, Service Lines, Behavioral Health, Chronic Care Management, Methodologies, Performance Improvement, Access to Care, Quality, Medicaid, Reimbursement, Finance

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Pediatric patients with behavioral health needs increasingly seek care at hospital emergency departments. Recent research indicates that pediatric ED visits due to behavioral health issues rose 25% between 1999 and 2007, with the most pronounced increase seen among uninsured and Medicaid/CHIP-covered children.1

Lack of access to outpatient mental health specialists is a major contributor to the rise in mental health ED visits. Access challenges are particularly acute among uninsured and publicly insured children—a population at elevated risk for behavioral health issues. A 2011 study conducted in Illinois found that psychiatrists statewide scheduled appointments only 17% of the time for children with public insurance versus 51% of the time for children with private insurance.2

Hospitals EDs are ill-equipped to provide adequate treatment for pediatric patients with behavioral health issues. First, by nature, episodic ED treatments do not provide the longitudinal care necessary to improve mental health outcomes. Moreover, many EDs do not possess the staff expertise or infrastructure to manage pediatric behavioral health cases. Accordingly, pediatric mental health visits commonly result in protracted ED stays and/or transfer3, both of which place significant strain on ED capacity and hospital resources.

Providers must improve ambulatory access to behavioral health screening and treatment to reduce the growing volume of pediatric behavioral health cases presenting in the ED. Provided below are two key recommendations for hospitals and health systems seeking to better manage pediatric behavioral health volumes.