PC1038: Rural Health Perspectives of Emergency Care for Children with Acute Mental Health Conditions

Purpose/Objectives: Addressing the acute mental healthcare needs of children is a challenge nationwide. Large increases in the number of children presenting to Emergency Departments (EDs) during the Covid-19 pandemic with acute mental healthcare conditions has put extreme strains on children, families, and the limited infrastructure that exists. This has resulted in children far exceeding Joint Commission standards for length of stay in EDs for mental health, frequently referred to as ED boarding. Further, although a large majority of children present for mental health conditions to non-children’s hospital EDs, most pediatric mental healthcare resources are concentrated at children’s hospitals. Despite these challenges and disparities in resources, there are no prior studies that capture parent/guardian opinions and perspectives on acute pediatric mental healthcare among those with the highest level of need in a general ED in a rural state. The objective of this Quality Improvement project was to assess parent/guardian opinions and perspectives of acute care for children with mental health conditions boarding in a general ED in a rural state.

Design/Methods: We performed semi-structured interviews of parents/guardians of patients (under 18 years old) with a primary mental health condition boarding in a general ED (length of stay ≥ 24 hours). An interview guide was developed a priori and reviewed among key stakeholders. A trained study team performed the interviews. A coding tree was developed through an iterative process that included double-coding transcripts and monitoring of inter-rater reliability to perform thematic analysis.

Results: Fourteen interviews were conducted. Key themes elicited from parent/guardians included access to mental healthcare services, mental healthcare delivery, care setting, minor autonomy, and level of support for families and caregivers. Parents/guardians identified challenges in all the themes, as well as suggested areas of improvement across the healthcare continuum. All major themes and subthemes were quantified using NVivo software, with the most prevalent among all populations including the following: coordination of care, staff-to-parent communication, available resources in the Emergency Department, access to mental health services (both inpatient and outpatient), and the general ED care setting.

Conclusion/Discussion: Parents/guardians face considerable challenges in attaining timely and appropriate mental healthcare for their children. Immediate and innovative resource allocation is needed across the healthcare continuum to bolster the acute mental healthcare services currently offered to children and families, especially in general and rural EDs.