A Systems Approach to Pediatric Mental and Behavioral Healthcare in Emergency Departments: Recommendations From a National Workshop

Abstract

Background

Pediatric patients increasingly seek care for mental and behavioral health (MBH) conditions in Emergency Departments (EDs). Yet, ED environments are poorly designed, organized, and equipped to deliver safe, effective care to these patients. There is an urgent need for solutions that improve safety and care quality and support provider wellbeing. To address this need, our team brought together experts from across the United States to identify and prioritize the most urgent challenges for further study and design intervention.

Methods

A workshop held in September 2023 brought together 61 multidisciplinary experts and clinical stakeholders to identify, prioritize, and brainstorm solutions for the most urgent challenges facing EDs in providing care to pediatric MBH patients. Breakout groups built upon presentations from leaders in pediatric emergency healthcare and the research team's study findings to identify the six most critical challenges and brainstorm possible systems-based interventions to solve them.

Results

Key challenges included accommodating families, supporting flexibility and adaptability, respecting patient dignity and humanity, optimizing communication, minimizing the psychological effects of boarding, and safely supporting coping. The ideas generated in this workshop indicate that built environment interventions that facilitate flexible caregiving, support sensory environment control, and balance patient privacy with staff monitoring and ED policy and process interventions that clarify care team roles and standardize processes may support pediatric MBH care better.

Conclusions

The ideas generated in this serve as a framework and catalyst for researchers and health systems interested in developing systems-based solutions to the complex challenges of pediatric emergency mental healthcare.