Follow-Up Care Missing for Half of Kids with Mental Health Emergencies

Researchers found that only 56 percent of children receiving emergency care for mental health crises get necessary follow-up care, a concerning finding given the pediatric mental health crisis.

A recent study showed that rates of follow-up care are lacking among children with mental health emergencies, underscoring the need for stronger patient engagement after hospitalization.

These findings come in the midst of the ongoing pediatric mental health crisis in the United States, which was only amplified by the coronavirus pandemic.

The study, which included more than 28,000 Medicaid-enrolled children ages 6 to 17, found that less than one-third had follow-up care within seven days of being discharged from a mental health emergency visit from January 2018 to June 2019.

As time went on, the rates showed little improvement, with only 56 percent receiving follow-up care within 30 days following discharge.

Researchers noticed that children without prior mental health outpatient care were the least likely to have follow-up care appointments, said Jennifer Hoffmann, MD, MS, the study’s lead author and an emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago.

“Clearly, we need to do better for children who come to the emergency department (ED) in a mental health crisis. Interventions to link to outpatient mental health care should prioritize follow-up within five days of a mental health ED discharge,” Hoffman, who is also an assistant professor of Pediatrics at Northwestern University Feinberg School of Medicine, said in the press release.

“To improve follow-up after mental health ED visits, we need to focus on children with new diagnoses who have not previously engaged in outpatient mental health care,” Hoffmann added. “Future research should assess specific strategies to promote outpatient follow-up, such as care coordination and use of telemedicine.”

The study also highlighted some racial disparities. The rate of timely follow-up among Black children was notably lower at the 30-day mark.

Researchers emphasized that stigma, a lack of diverse provider options, and transportation obstacles have created barriers to accessing mental healthcare for pediatric patients.

“Our results show the dire need to improve access to outpatient mental health services for children,” said Hoffmann.

“We especially need to remove barriers to mental healthcare for Black children. Strategies may include reducing stigma in seeking mental health care, improving diversity in the pediatric mental health workforce, and increasing availability of community and school-based mental health services.”

The researchers pointed out that the National Child Core Set of quality measures now includes follow-up within seven and 30 days of a mental health ED visit for children between 6 and 17 years old. Starting in 2024, state Medicaid agencies will be required to report annual adherence rates to this standard.

Changing public policy is important to improve engagement and provide greater education during post-discharge, but health systems will need their own organizational strategies to make sure they can adhere to regulations.

A 2022 study showed that even automated phone calls could be a viable option to enhance patient engagement and education in the ED setting, although there is limited study in how these work for pediatric mental health cases.

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