JMIR Publications

ABSTRACT

Background:

Pediatric mental health emergency department (ED) visits are increasing at 6-10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are re-admitted in the following weeks. Hospitals do not have the resources to meet escalating youth mental health needs. Intensive Outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED’s in order to prevent readmissions.

Objective:

The purpose of this program evaluation was to assess 1) whether youth and young adult ED admission rates decreased following participation in a remote, intensive outpatient program and 2) whether there were differences in readmission rates between youth and young adults by gender or sexual identity, race, or ethnicity.

Methods:

Data were collected from intake and 3-month post-discharge surveys for 735 clients who attended at least six sessions of a remote IOP for youth and young adults. Patients reported if they had been admitted to an emergency room within the previous 30 days and the admission reason. Over half of clients were adolescents (58%) and the rest were young adults (42%) (M = 18.25, SD = 4.94). The sample was diverse in gender (49% female, 29% male, 10% non-binary) and sexual identity (39% heterosexual, 22% bisexual, 10% pansexual, 27% other sexual identity), and represented several races (79% white, 10% Black, 2% Indigenous, 2% Asian, 7% other) and ethnic identities (25% Hispanic, 6% other ethnic identity).

Results:

Mental health-related ED admissions significantly decreased from intake to 3-months post-discharge such that 94.2% of clients with a recent history of mental health-related ED admissions at IOP intake reported no mental health-related ED admissions in the 3 months post-discharge from treatment, χ2(1)=38.88, P<.001. There were no differences in ED admissions at intake or in improvement at 3 months post-discharge by age, gender, sexuality, race, or ethnicity.

Conclusions:

This study documents low mental health-related ED readmission rates when youth and young adults engage with intensive outpatient care following emergency room visits, suggesting remote intensive outpatient services provide care that meet youth and young adult mental health acute needs after ED discharge. The similar outcomes across demographic groups indicate that the current tracks of programming are equally meeting needs. Future research could conduct a full return on investment analysis for intensive mental health services for youth and young adults. Clinical Trial: NA