“I stumbled upon some literature about the number of children who come to the emergency room for mental health-related issues but aren’t actually hospitalized,” said Smith, a faculty member in UVA’s Youth-Nex Research Center. Told. “This was an eye-opener because we realized that while there was a small but growing body of research on the transition from hospital to school, there was virtually no research on the transition from the emergency department to school. .”
As an iTHRIV Scholar, Ms. Smith will work with UVA School of Medicine colleagues Dr. Moira Smith and Dr. Genevieve Lyons with a grant from the 4-VA organization to support students returning to school after an emergency room visit. We are researching the best methods.
To better understand this problem and how to close the gap, we spoke to Lora Smith.
Q. How many students seeking mental health care in the emergency department are admitted and discharged on the same day?
A. The majority of children who come to the emergency department for mental health problems are discharged from the hospital without being hospitalized. This number varies by study and region, including available resources. In some cases, only 8% of children who come to the emergency department are admitted.
Approximately 30% to 40% of children presenting to the emergency department are referred by school. Clearly, they are being referred because their needs are beyond what the school can do at any given moment. And in many cases, the child returns to school the next day because he or she was not admitted.
Q. How does that impact school mental health professionals?
A. Many school mental health professionals have no formal training on how to best support children returning to school after a mental health crisis. But many of them are good at it because they learn on the job and from their colleagues.
Most people we interviewed shared that their schools have some kind of protocol, formal or informal, for hospital-to-school transitions. However, they did not think about the transition from the ED to school in the same way. While not enough is being done to transition from hospitals to schools, even less is being done to transition from emergency departments to schools.
Q. Why won’t my student get the support he needs when he returns to school?
A. One barrier is the disparity in services across the continuum of care for young people with mental health concerns. Schools and emergency departments often don’t agree on the definition of “immediate risk.” School mental health professionals tend to have lower standards of acceptance. This means school policies and procedures may require that children who need mental health services be sent to the emergency department. However, the same student may not meet the standards for the level of care provided at the hospital, according to the emergency department.
Another problem is the communication gap. Federal privacy laws such as HIPAA and FERPA have privacy concerns and issues. So if you don’t tell the school that your family member went to the hospital, the school will most likely have no way of knowing.
Some families may not trust schools, and others may have a stigma about the need for mental health care. This speaks to the need to build trust and relationships between schools and families.
Q. As a clinical psychologist/school psychologist, what kind of support would you like to provide to students?
A. There’s something called an “interconnected systems framework,” where you integrate community and mental health resources with what’s available in schools. These frameworks can help build stronger collaborations and partnerships with schools, health systems, and other community health providers and resources. Ideally, adults can actively support children with mental health problems throughout the care continuum, preferably by providing the necessary outpatient care to prevent emergency department visits and hospitalization. It will look like this. It requires a lot of planning and collaboration, thinking far beyond the individual child in the emergency department.
More immediately, schools need to be aware of not only emergency department visits, but also what else is going on and how schools are working to help children meet their academic, social, emotional, and mental health. You can start holding a school re-admission meeting to discuss what would be most helpful. needs. It also requires ongoing follow-up and progress monitoring to ensure that the child’s needs are being met, as well as school re-entry interviews.
What I really want to highlight is how we can integrate other adults into schools to support children. Teachers, administrators, and school mental health professionals are being pulled in very different directions. There are also people in the school building, such as secretaries and custodians, who support the overall well-being of students. With appropriate confidentiality and privacy measures in place, we would love to have them in the loop and on our team.
Even if it’s a high five or a “I’m glad to see you today!” It can brighten a child’s day back to school. Any adult in the school building can do that.
