389 - Children in Mental Health Crisis: Pediatric Primary Care Providers’ Role in Bridging Treatment Following Higher Levels of Care

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 389
Publication Number: 389.231

Rebecca A. Ferro, Johns Hopkins University School of Medicine, Ballwin, MO, United States; Sarah Edwards, University of Maryland School of Medicine, Baltimore, MD, United States; Kelly Coble, University of Maryland (MACS & BHIPP), Baltimore, MD, United States; Mark A. Riddle, Johns Hopkins University School of Medicine, COLUMBIA, MD, United States; Shauna P. Reinblatt, University of Marylad SOM, Baltimore, MD, United States; Chelsie M. Ader, UMB, Baltimore, MD, United States; Meghan Crosby Budinger, University of Maryland, Baltimore, Forest Hill, MD, United States; Amie F. Bettencourt, Johns Hopkins School of Medicine, Baltimore, MD, United States

Presenting Author(s)

Rebecca A. Ferro, MA (she/her/hers)

Research Program Coordinator
Johns Hopkins University School of Medicine
Ballwin, Missouri, United States

Background: Increasingly, children are experiencing mental health crises necessitating treatment within a higher level of care. Recent research shows significant increases in visits to pediatric emergency departments for mental health concerns (Hoffman et al., 2019; Leeb et al., 2020). Child Psychiatry Access Programs (CPAP) like Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) provide critical support to primary care providers (PCPs) in addressing the mental health concerns of their pediatric patients. Many PCPs contact BHIPP for assistance following their patients’ discharge from a higher level of care.

Objective:

The purpose of this study is to examine characteristics of patients recently seen in a higher level of care for whom PCPs sought psychiatric consultation and referral support from BHIPP. This study will elucidate the role of pediatric PCPs in bridging treatment for youth who have experienced mental health crises.

Design/Methods:

Psychiatric consultation and referral calls to BHIPP between October 2012 and December 2021 were included if a) the patient was recently seen in a higher level of care and b) the PCP was bridging treatment following the patient’s discharge. N = 211 calls met criteria. Descriptive and chi-square analyses were used to examine patient and call characteristics.

Results:

The most common mental health concerns of pediatric patients recently seen in a higher level of care for whom PCPs contacted BHIPP included depressed mood, suicidal thoughts/gestures, and anxiety. Over half of the patients called about had two or more mental health diagnoses. At the time of the call, only one quarter of these patients had outpatient therapy services in place while about half were receiving medication treatment. A majority of these patients were discharged from the higher level of care without a care plan in place. Pediatric PCPs bridged treatment following patient discharge in the following ways: increased monitoring of patient symptoms, coordinating referrals to mental health services, and providing medication management.

Conclusion(s):

Pediatric PCPs are managing their patients’ complex mental health concerns following receipt of higher levels of care. The number of patients within this sample discharged from higher levels of care without care plans is concerning. Improvements in collaboration and care coordination between pediatric PCPs and emergency department providers are needed. CPAPs can help promote communication between PCPs and emergency departments, provide training on medication management, and share information about local mental health services.