Collaboration, Innovation, and Consensus Gathering: Addressing the National Pediatric Mental Health Crisis

In the fall of 2021, the Children's Hospital Association (CHA), American Academy of Child and Adolescent Psychiatry (AACAP), and the American Academy of Pediatrics (AAP) declared a mental health emergency among youth. Shortly after, the US Surgeon General also declared of state of pediatric mental health emergency. These declarations were made largely due to limited access to mental health services coupled with an increased number of youth presenting to emergency departments seeking mental health care, which was exacerbated by the COVID-19 pandemic. As healthcare systems are working to meet this demand, there is limited guidance as to what practice models exist in the field of Child and Adolescent Emergency Psychiatry. Here we describe several collaborative efforts to establish greater understanding of the current crisis, models of care, and best practices. This virtual symposium will review the findings of existing data related to pediatric boarding: including outcomes in the care of youth who are boarding, current service models, as well as consensus guidelines on pediatric boarding.

Breakdown of the Symposium:

15 minutes: Dr. Ibeziako will review of current pediatric emergency mental health trends, including pediatric boarding within the emergency and inpatient medical settings. This section will describe changes in pediatric mental health crisis presentations pre- and post-pandemic

30 minutes: Dr. Malas will review the results of a survey performed by the American Association for Emergency Psychiatry (AAEP) reviewing current Child and Adolescent Emergency Psychiatry service, staffing, and reimbursement models. This survey was completed by psychiatrists, child psychiatrists, and emergency medicine physicians and discusses current trends in service delivery. Dr Malas will then review Pediatric Boarding Consensus Guidelines developed through the American Academy of Child and Adolescent Psychiatry Emergency Psychiatry Committee. This guideline was created in collaboration with child and adolescent psychiatrists and pediatricians from 17 different hospital systems. The consensus guidelines will include a review of best practices in the care of youth boarding, as well as a description of what services are provided to this population while awaiting an inpatient psychiatric bed.

30 minutes: Dr Schott will review the American Academy of Pediatrics Clinical Report on Pediatric Mental Health Boarding. This paper will review the clinical report created by pediatricians and child and adolescent psychiatrists about the standards that should be included when boarding a child for mental health concerns. This clinical report prioritized boarding on the medical units and was primarily written by pediatricians with keeping in mind Joint Commission Guidelines.

15 minutes: During the final 15 minutes, Dr. Ibeziako will describe outcomes of a comprehensive approach to reduce pediatric mental health boarding and advocacy efforts that can be pursued to help promote improved care, including a discussion of issues related to health equity, quality, and access.

References:

Leith T, Brieger K, Malas N, et. al. “Increased prevalence and severity of psychiatric illness in hospitalized youth during COVID-19.” Clin Child Psychol Psychiatry 2022; 27(3): 804-812

Ibeziako P, Kaufman K, Scheer KN, Sideridis G. Pediatric Mental Health Presentations and Boarding: First Year of the COVID-19 Pandemic. Hosp Pediatr. 2022;12(9):751-760.