121 - Feasibility and Acceptability of Implementing an Acute Behavioral Health Crisis Stabilization Protocol in a Pediatric Emergency Department

Publication Number: 1111.121

Michael Harries, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Danielle Cory, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Moshe Bitterman, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jonathon Wanta, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Aron Janssen, Northwestern University The Feinberg School of Medicine, Evanston, IL, United States; Rebecca Barber, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Douglas Lorenz, University of Louisville, Louisville, KY, United States; Jennifer A.. Hoffmann, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Acute crisis stabilization during behavioral health observation (BHO) in the pediatric emergency department (ED) is an emerging care model for youth with mental illness. Previous work found BHO was associated with reduced length of stay and lower inpatient admission rates. However, prior studies have not examined delivery of specific evidence-based treatments, such as the Collaborative Assessment and Management of Suicidality (CAMS), during BHO or its acceptability to patients.

Objective: We aimed to examine the feasibility and acceptability of BHO in a pediatric ED, which incorporated use of CAMS for patients in BHO with suicidal thoughts or behaviors.

Design/Methods: We conducted an observational study examining the feasibility and acceptability of BHO in an academic children's ED. Placement into BHO was at the discretion of the treating clinician. Feasibility was defined by the number of patients enrolled in BHO, the number of patients in BHO who received CAMS, and the association of BHO implementation with ED operational metrics (length of stay, discharge rates, return rates) among encounters by patients ages 5-17 who received a psychiatric consult. Operational metrics were measured using electronic health record data from Oct 2021 – Sept 2025 and compared before and after BHO implementation (in Oct 2023) using Wilcoxon rank sum and Fisher exact tests. Acceptability was measured through surveys of patients ages 13-17 who received CAMS while in BHO.

Results: We included 3759 behavioral health ED visits, of which 1822 (50%) occurred after implementation of BHO. Compared before BHO implementation, behavioral health ED visits after BHO implementation had decreased length of stay from 7 to 6 hours (p <.001), higher discharge rates (65% vs. 55%) (p <.001), and increased mental health-related returns within 30 days (7% vs. 5%) (p <.01) (Table 1). Of 86 BHO encounters, 60 (70%) resulted in discharge and 7 (8%) had a mental health-related return within 30 days (Table 2). Of 34 eligible patients who received CAMS, 16 (47%) completed acceptability surveys. Of these, 94% agreed or strongly agreed they would recommend CAMS to others (Table 3).

Conclusion(s): Implementation of BHO in a pediatric ED was associated with decreased length of stay for behavioral health ED visits, but increased return visits. Use of CAMS during BHO was highly acceptable to patients. Prospective studies that include a control group are needed to evaluate the effectiveness of CAMS in preventing admissions and in reducing suicidal thoughts and behaviors among youth in the ED.

Table 1. Characteristics of Behavioral Health ED Visits Before and After Implementation of Behavioral Health Observation
PAS_Table 1.pdf

Table 2. Characteristics of ED Visits by Patients Placed in Behavioral Health Observation
PAS_Table 2.pdf

Table 3. Acceptability of Collaborative Assessment and Management of Suicidality (CAMS) among patients in Behavioral Health Observation
PAS_Table 3.pdf