Emergency department pediatric psychiatric services Measurement of variation and identification of best practice Jennifer Field Brown, Ph.D., MSN, BSN, BA Assistant Professor • School of Nursing • Virginia Commonwealth University • Richmond, VA, USA Purpose The purpose of this study is to evaluate the feasibility of a proposed data measurement and collection procedure for identifying ED pediatric psychiatric service characteristics. This pilot will examine such services across the Commonwealth of Virginia. Discussion and conclusions Problem Methods target sample=70 hospitals; 39 responses to date, (56%) online:35, mail:4, phone:0 recruitment has been difficult, requiring multiple follow up contacts - had to extend data collection period average time spent to complete online survey:24 min most EDs offer psychiatric service but pediatric specialists RARE Variability in the training of psychiatric staff Ratings of service quality middle-of-the-road ED pediatric psychiatric visits unpredictable and challenging to manage Survey effective in capturing variation in ED pediatric emergency services. The findings will guide improvements to the research design for replication using a national sample. Such research will inform legislators, hospitals, and other personnel involved in ED pediatric psychiatric service development and evaluation. Annual volume of pediatric psychiatric visits to hospital emergency departments (EDs) continues to increase significantly, but little is known about the mental health services that are provided to children and adolescents in this setting Lack of information to guide “best practices” related to pediatric psychiatric emergency services Most existing research limited to single organization or geographic location Limited usability of secondary datasets - Research on prevalence of ED pediatric visits for psychiatric services using National Ambulatory Care Hospital Survey cannot capture organizational influences – need for additional data Need for systematic identification and comparison of ED pediatric psychiatric services within and across regions/states PI revised an instrument she had designed for a previous study of adult ED psychiatric services (Brown, 2005) 31-item ED Pediatric Psychiatric Services Survey used to obtain information about ED management of children who present with a mental health problem Identified target sample for pilot test (nonfederal acute-care facilities within the Commonwealth of Virginia) using 2006 American Hospital Association Dataset Contacted each hospital to identify appropriate respondent (ED nurse manager/administrator) Offered participants choice of response methods: online, paper & pencil/mail, phone interview Administered survey over 6 month period, combined survey data with AHA data to examine association between organizational characteristics and ED pediatric psychiatric service variation In process of conducting descriptive and inferential analyses Findings Background Recommendations/ Future Directions Statistics support the need for pediatric psychiatric emergency services in Virginia to improve the identification and treatment of illness. The estimated number of Virginia children and adolescents between 9 and 17 years of age with a serious emotional disturbance was between 80,017 and 97,801.* Yet less than a third are receiving appropriate treatment. In 2006, 30,000 children and adolescents received mental health and substance abuse services in the community mental health system. In addition, the state psychiatric hospitals served 887 children. Sample - Include freestanding EDs, replicate with national/international sample Survey - further revision??, implement strategies for improving response rate Data - Identify additional sources for objective descriptive information Further research to identify disparities in EDPES structures and outcomes, to determine causality, and to identify what constitutes best practice – include analysis of the association of geographical (rural/urban, state) and demographical (patient race/ethnicity) characteristics * Estimate made using an accepted methodology for estimating prevalence of serious emotional disturbance (Friedman et. al., 1998) and year 2000 census data, Data were insufficient to make prevalence estimates for children younger than nine. This project was supported by a grant from the A.D. Williams Foundation at Virginia Commonwealth University. V i r g i n i a C o m m o n w e a l t h U n i v e r s i t y