Outcomes Following a Mental Health Care Intervention for Children in the Emergency Department
Authors: Newton Amanda S. , Thull-Freedman Jennifer , Xie Jianling , Lightbody Teresa , Woods Jennifer , Stang Antonia , Winston Kathleen , Larson Jacinda , Wright Bruce , Stubbs Michael , Morrissette Matthew , Freedman Stephen B. ,   Pediatric Emergency Research Canada (PERC), Ali Samina , Alquarashi Waleed , Burstein Brett , Crawford Tyrus , Eaton Andrea , Freire Gabrielle , Fric Michelle , Poonai Naveen , Wright Bruce , Zemek Roger 
Published: February 2025

ImportanceThe emergency department (ED) is an important safety net for children experiencing mental and behavioral health crises and can serve as a navigational hub for families seeking support for these concerns.ObjectivesTo evaluate the outcomes of a novel mental health care bundle on child well-being, satisfaction with care, and health system metrics.Design, Setting, and ParticipantsNonrandomized trial of 2 pediatric EDs in Alberta, Canada. Children younger than 18 years with mental and behavioral health presentations were enrolled before implementation (preimplementation: January 2020 to January 2021), at implementation onset (run-in: February 2021 to June 2021), and during bundle delivery (implementation: July 2021 to June 2022).InterventionThe bundle involved risk stratification, standardized mental health assessments, and provision of an urgent follow-up appointment after the visit, if required.Main Outcomes and MeasuresThe primary outcome, child well-being 30 days after the ED visit, was assessed using the Stirling Children’s Wellbeing Scale (children aged &amp;lt;14 years) or Warwick-Edinburgh Mental Wellbeing Scale (children aged 14-17 years). Change in well-being between the preimplementation and implementation periods was examined using interrupted time-series analysis and multivariable modeling. Changes in health system metrics (hospitalization, ED length of stay [LOS], and revisits) and care satisfaction were also examined.ResultsA total of 1412 patients (median [IQR] age, 13 [11-15] years), with 715 enrolled preimplementation (390 [54.5%] female; 55 [7.7%] First Nations, Inuit, or Métis; 46 [6.4%] South, Southcentral, or Southeast Asian; and 501 [70.1%] White) and 697 enrolled at implementation (357 [51.2%] female; 51 [7.3%] First Nations, Inuit, or Métis; 39 [5.6%] South, Southcentral, or Southeast Asian; and 511 [73.3%] White) were included in the analysis. There were no differences between study periods in well-being. Reduced well-being z scores were associated with mood disorder diagnosis (standardized mean difference, −0.14; 95% CI, −0.26 to −0.02) and nonbinary gender identity (standardized mean difference, −0.41; 95% CI, −0.62 to −0.19). The implementation period involved fewer hospitalizations (difference in hospitalizations, −6.9; 95% CI, −10.4 to −3.4) and longer ED LOS (1.1 hours; 95% CI, 0.7 to 1.4 hours). There were no differences between study periods in ED revisits or care satisfaction.Conclusions and RelevanceIn this study, the delivery of a care bundle was not associated with higher child well-being 30 days after an ED visit. Hospitalizations did decrease during bundle delivery, but ED LOS did not. These health system findings may have been affected by broader changes in patient volumes and flow processes that occurred during the COVID-19 pandemic, which took place as the study was conducted.Trial RegistrationClinicalTrials.gov Identifier: NCT04292379