75 - An upstream approach to identify children at risk for mental health concerns: Association between pediatric resilience and mental health emergency department visits

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 75
Publication Number: 75.149

Nora L. Vish, Dayton Children's Hospital, Dayton, OH, United States; Adrienne Stolfi, Wright State University, Dayton, OH, United States; Sara Huber, Wright State University Boonshoft School of Medicine, Beavercreek, OH, United States; Sue L. Fralick, Dayton Children's Hospital, Dayton, OH, United States

Presenting Author(s)

Nora L. Vish, MD, MPH (she/her/hers)

Physician
Dayton Children's Hospital
Dayton Children's Hospital
Dayton, Ohio, United States

Background: Resilience mitigates the effects of toxic stress on health. The Student Resiliency Program (SRP) serves children impacted by trauma and social needs in Dayton, OH public schools. Children with high Adverse Childhood Event scores and social needs inequities are more likely to seek care in emergency departments (ED), resulting in fragmented care and poor utilization of resources.

Objective:

This study examines resilience scores in school children referred to the SRP and the association with ED utilization.

Design/Methods: A retrospective chart review was conducted of children aged 4-18 years referred to the SRP from Aug 2020-Mar 2022. Data included age, gender, race/ethnicity, need for educational support, and resilience scores. Resilience was measured using the parent-reported Behavioral Emotional Rating Scale (BERS-2) Strength Index (SI) score, a validated strength based assessment. Total SI scores are standardized to a mean of 100 and standard deviation (SD) of 15, with higher scores indicating higher resilience. SI scores were transformed to z-scores for analyses. The primary outcome was the number of ED visits for mental health (MH) in the year prior to assessment, and secondary outcomes were ED visits for illness and trauma. The mean (SD) SI score was compared to the standardized score with a one-sample t test. Associations between demographics and ED visits (none vs. ≥one) were made with chi-square or Fisher’s exact tests. SI z-scores were compared among children grouped by number of ED visits using analysis of variance. Logistic regression was used to determine the adjusted odds ratio (AOR) of ≥one ED visit for a one-SD decrease in SI z-score, controlling for age and gender.

Results: BERS-2 SI scores were available for 375/420 (89%) children from 59 schools. Demographics and number of MH ED visits are shown in Table 1. Older age and female gender were associated with ≥one MH ED visit. There were no associations between demographics and ED visits for illness or trauma. Mean (SD) SI score was 86 (18), significantly lower than the normed mean of 100 (P< 0.001). Children with MH ED visits had lower SI z-scores than children with no MH ED visits (Table 2). The AOR (95% confidence interval) of having ≥one MH ED visit was 1.44 (1.08-1.90) for a one-SD decrease in SI z-score after adjusting for age and gender.

Conclusion(s): Resilience programs in public schools are an effective upstream approach to identify children at risk for increased mental health concerns. The SRP appropriately identified children with lower resilience scores, which were associated with increased ED utilization for mental health.