2023 14th Annual NUBE Conference

Across the United States, there is a crisis with accessing mental health services. The volume of children in need surpasses the capacity for urgent psychiatric services. As a result, many children utilize the Emergency Department to meet their needs. Mental health safety nets are inadequate and non-existent at times, which can lead to psychiatric admissions. Children awaiting bed placement may linger in the Emergency Department for days or weeks. Generally, during this time, mental health treatment is not specific to their needs, but solely focuses on safety. This pediatric mental health crisis requires unique solutions. At Cincinnati Children’s Hospital Medical Center (CCHMC), the number one ranked pediatric hospital in the country, a team of over 70 emergency department psychiatry employees manage the growing mental health system dilemma. At CCHMC Psychiatric Intake Response Center (PIRC), we created a designated point of access for families and/or providers to call when they are experiencing a crisis. This provides an alternative psychiatric assessment option outside of an ED setting. Our Crisis Assessment Team is available to respond to crisis calls from patients, caregivers, schools, and community agencies. Master’s level clinicians use standardized tools to assess risk and to provide treatment recommendations. Approximately 70% of the callers are directed to outpatient resources including our Bridge Clinic, mental health urgent care sites, or alternative levels of care. The entire community benefits with the Crisis Assessment Team as the access point. The PIRC at Cincinnati Children’s Hospital identified the lack of psychiatric treatment options for at-risk children evaluated in the Emergency Department. Children are evaluated and discharged with referrals, but there is no guarantee of their ability to access therapy and/or medication evaluation in a timely manner. In addition, some of the children evaluated can be better served by receiving a psychiatric evaluation outside of the Emergency Department. The Bridge Clinic was created in 2017 to provide an alternative psychiatric assessment and stabilization option for children presenting in crisis and who need assistance coordinating ongoing mental health treatment. The Bridge objectives are: •to minimize unnecessary Emergency Department visits.•to provide an alternative level of care to support Emergency Department discharge.•to provide crisis management interventions for safety and stabilization.•to support transition to ongoing mental health treatment. In summary, the Bridge Clinic partners with families to help them navigate through their mental health crisis to support them in their next steps towards mental health wellness. The collaborative efforts of our Crisis Assessment Team and Bridge Clinic offer unique solutions to mitigate the pediatric mental health crisis. Our programs work conjunctively to quickly assess the child’s crisis and to refer them to the appropriate level of care and treatment. These initiatives improve family and hospital system outcomes by decreasing strain on an already overwhelmed Emergency Department.

Learning Objectives:

1. Learners will understand how to build a Crisis Assessment Team (CAT) in a hospital setting, to manage mental health emergencies prior to patients stepping foot in the facility. This will include establishing buy-in from community partners.
2. Learners will understand how a Bridge Clinic provides an alternative option for an urgent psychiatric evaluation outside of an Emergency Department setting.
3. Learners will be able to understand the importance of collaboration and interaction between crisis programs within our hospital system.