Failure of Psychiatric Referrals from the Pediatric Emergency Department
Author Information
Author(s): Jacqueline Grupp-Phelan, Sergio V Delgado, Kelly J Kelleher
Primary Institution: Cincinnati Children's Hospital Medical Center
Hypothesis
Identification of mental health problems in the ED followed by brief, problem oriented interventions and referral may improve on health-care seeking behavior and quality of life for the child.
Conclusion
Children screened in the ED for unrecognized mental health problems are very unlikely to follow-up for a mental health evaluation with or without an enhanced referral.
Supporting Evidence
- Overall, 81% of children screened positive for a mental health problem.
- Only 6 families completed the psychiatric follow-up evaluation.
- Families reported barriers to treatment engagement including feeling problems were not 'bad enough'.
- Access and financial barriers to the initial mental health evaluation were removed.
Takeaway
The study found that kids who were checked for mental health issues in the emergency room didn't really go for follow-up help, even when they were given extra support.
Methodology
A prospective randomized control trial comparing an enhanced referral vs. simple referral in families of children screened for mental health symptoms.
Potential Biases
The use of a research assistant instead of a seasoned provider may have affected the intervention's effectiveness.
Limitations
The study was prematurely terminated due to low engagement rates, and the sample size did not reach the a priori target.
Participant Demographics
Children aged 4-18, with a higher proportion of African American and male participants in the enhanced referral group.
Statistical Information
P-Value
0.13
Confidence Interval
95% CI 0.3–2.14
Digital Object Identifier (DOI)
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