Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs

Fendrich, Michael; Ives, Melissa; Kurz, Brenda; Becker, Jessica; Vanderploeg, Jeffrey J.; Bory, Christopher T.; Lin, Hsiu‐Ju; Plant, Robert W.

doi:10.1176/appi.ps.201800450

Cited by 33 publications

(37 citation statements)

References 20 publications

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“…Up to 50% of children and youth admitted to psychiatric inpatient units experience boarding (waiting for an extended time) in EDs or medical inpatient units, sometimes for days (McEnany et al, 2020 ) Reducing ED utilization 16. There are promising initiatives to reduce ED utilization through mobile and community crisis services, START programs, and learning communities focused on EDs and their community partners (Fendrich et al, 2019 ; Kalb et al, 2016 ) a Some data has been simplified for presentation in the Fact Sheet format. Additional data is available in the body of the article and the cited sources …”

Section: The Approachmentioning

confidence: 99%

“…There are, however, at least three areas of work that have shown recent promise. An analysis of Connecticut Medicaid data found a significant reduction in the odds of a repeat ED visit and total number of ED visits among children and youth who received mobile crisis services in comparison to those who were not mobile crisis recipients (Fendrich et al, 2019 ). At a large urban hospital in Brooklyn, New York, the establishment of an outpatient Urgent Evaluation Service appeared effective in reducing unnecessary pediatric ED mental health visits among predominantly Medicaid insured Latinx, Chinese, and South Asian immigrant populations (Alvarado et al, 2020 ).…”

Section: Categories Of Informationmentioning

confidence: 99%

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Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Hoge

Vanderploeg

Paris

et al. 2022

Community Ment Health J

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There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

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Section: The Approachmentioning

confidence: 99%

Section: Categories Of Informationmentioning

confidence: 99%

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Hoge

Vanderploeg

Paris

et al. 2022

Community Ment Health J

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“…The virtual and 24/7 access provided by helplines may be especially critical during the natural disasters and public health emergencies like the COVID-19 pandemic, when the formal behavioral healthcare system may be less accessible and anxiety levels and social isolation may be heightened (Costa et al, 2020 ). Helplines may also offer an important alternative to using emergency services, along with other resources such as mobile crisis response (Fendrich et al, 2019 ) or referrals to other mental health services.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction and Mental Health Outcomes Associated with a Large Regional Helpline

McClellan

Hunt

Olsho

et al. 2022

Community Ment Health J

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We surveyed users of a behavioral health helpline serving New York City and surroundings, to assess their helpline experiences, changes in psychological distress after contacting the helpline, and factors associated with differences in these measures. We surveyed users twice: roughly 2 weeks following their helpline contact, from 4/2019 to 9/2019 (N = 1097 respondents) and again 6 months following contact, from 10/2019 to 3/2020 (N = 732 respondents). Eighty-nine percent of respondents reported that contacting the helpline helped them deal a little or a lot more effectively with their problems. Rates of psychological distress decreased from 41.3% 2 weeks following helpline contact to 29.0% 6 months after (P < 0.05). Improvements in psychological distress were found across a range of demographic characteristics and were greatest for repeat users. Users reported broadly positive experiences with the helpline and improved psychological distress 6 months later. Behavioral health helplines can offer beneficial services to diverse populations, complementing the formal behavioral healthcare system. Supplementary Information The online version contains supplementary material available at 10.1007/s10597-021-00931-5.

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“…9 Fendrich et al found that youths who received MCO services had decreased odds of having a behavioral health ED visit. 19 How MCO services may differentially affect adults vs youths is unknown. Our MCO program was focused on adult patients who had more limited family support, and that focus may have led to the increase in reported return visits.…”

Section: Discussionmentioning

confidence: 99%

Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis

Vakkalanka

Neuhaus

Harland

et al. 2021

WestJEM

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Introduction: Mental health and substance use disorder (MHSUD) patients in the emergency department (ED) have been facing increasing lengths of stay due to a shortage of inpatient beds. Previous research indicates mobile crisis outreach (MCO) reduces long ED stays for MHSUD patients. Our objective was to assess the impact of MCO contact on future ED utilization. Methods: We conducted a retrospective chart review of patients presenting to a large Midwest university ED with an MHSUD chief complaint from 2015–2018. We defined the exposure as those who had MCO contact and any MHSUD-related ED visit within 30 days of MCO contact. The MCO patients were 2:1 propensity score–matched by demographic data and comorbidities matched to patients with no MCO contact. Outcomes were all-cause and psychiatric-specific reasons for return to the ED within one year of the index ED visit. We report descriptive statistics and odds ratios (OR) to describe the difference between the two groups, and hazard ratios (HR) to estimate the risk of return ED visit. Results: The final sample included 106 MCO and 196 non-MCO patients. The MCO patients were more likely to be homeless (OR 14.8; 95% confidence interval [CI],1.87, 117), less likely to have adequate family or social support (OR 0.51; 95% CI, 0.31, 0.84), and less likely to have a hospital bed requested for them in the index visit by ED providers (OR 0.50; 95% CI, 0.29, 0.88). For those who returned to the ED, the median time for all-cause return to the ED was 28 days (interquartile range [IQR]: 6–93 days) for the MCO patients and 88 days (IQR: 20–164 days) for non-MCO patients. The risk of all-cause return to the ED was greater among MCO patients (67%) compared to non-MCO patients (49%) (adjusted HR: 1.66; 95% CI, 1.22, 2.27). Conclusion: The MCO patients had less family and social support; however, they were less likely to require hospitalization for each visit, likely due to MCO involvement. Patients with MCO contact presented to the ED more frequently than non-MCO patients, which implies a strong linkage between the ED and MCO in our community. An effective referral to community service from the ED and MCO and collaboration could be the next step to improve healthcare utilization.

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Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs

Cited by 33 publications

References 20 publications

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Satisfaction and Mental Health Outcomes Associated with a Large Regional Helpline

Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis

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