603 - Current and Desired Behavioral Health Resources for Children: A Survey of Illinois Emergency Departments

Publication Number: 1580.603

Jennifer A.. Hoffmann, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Kendall Arslanian, American Academy of Pediatrics, Chicago, IL, United States; Cindy Durr, SSM Cardinal Glennon Children's Medical Center, Edwardsville, IL, United States; Jennifer Monti, American Academy of Pediatrics, Itasca, IL, United States; Stephanie Atella, ICAAP, Chicago, IL, United States; Suhanee Mitragotri, University of California, San Diego School of Medicine, La Jolla, CA, United States; Ashley A. Foster, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Emergency department (ED) visits by children for behavioral health (BH) concerns have risen over the last decade. Despite this, little is known about available BH resources for children in EDs.

Objective: To understand current and desired resources to care for children presenting to Illinois EDs with BH concerns.

Design/Methods: We conducted a survey of nurse pediatric emergency care coordinators (PECCs) and nurse managers working in Illinois EDs listed in the Pediatric Facility Recognition Program from March 15 - June 30, 2025. Survey development was informed by input from Illinois partner organizations, pilot testing, and cognitive interviews. The survey assessed ED characteristics, pediatric BH policies and processes, barriers to care, and desired resources.

Results: We received survey responses from 65 (64%) of 101 eligible EDs, with respondents comprising 76.9% PECCs, 16.9% nurse managers, and 6.6% with both roles. Most (60%) EDs were in general hospitals without a pediatric inpatient unit, 22% were in critical access hospitals, and 67% had low ( < 4999) annual pediatric ED volume. In a typical week, most EDs (66%) had 0-5 pediatric patients present with a primary BH complaint. Of EDs, 77% reported having at least one pediatric BH patient experiencing boarding for >72 hours within the past year. Of EDs, 56% had access to on-site mental health professionals, while 44% reported availability of telemental health services. Two-thirds (67%) of EDs reported tracking quality measures for pediatric BH visits. Two-thirds (67%) of EDs reported that physical restraints for violent or self-destructive behavior were applied in < 1% of pediatric BH visits. Of EDs, 89% had a suicide-related policy with pediatric considerations. Universal suicide risk screening was reported in 88% of EDs, most often starting at age 8 (36%) or 12 (30%). Commonly used screening tools were the Columbia Suicide-Severity Rating Scale Screen Version (87%) and Ask Suicide-Screening Questions (20%). Figure 1 displays reported suicide assessment and intervention practices. Half (50%) of EDs reported always or almost always providing all recommended elements of safety planning. Only 37% of EDs always or almost always provided information about recommended firearm storage practices, while 14% of EDs always or almost always provided firearm storage devices. Figure 2 illustrates commonly reported barriers to providing pediatric BH care, and Table 1 lists desired pediatric BH resources.

Conclusion(s): Survey findings demonstrate variation in pediatric BH care processes, common barriers, and prioritized solutions to improve pediatric BH care in EDs.

Figure 1. Suicide Assessment and Intervention Practices for Youth in Illinois Emergency Departments
"Assess" refers to ED practices involving evaluation for current and past suicidal thoughts/behaviors and access to lethal means. "Act" refers to ED management practices in which providers help or engage children who present with suicidal thoughts/behaviors in the delivery of suicide risk reduction services.

Figure 2. Top Barriers to Provision of Pediatric Behavioral Health Care in Emergency Departments


Table 1. Desired Resources for Pediatric Behavioral Health Care in Emergency Departments