602 - A Research Agenda for Acute Pediatric Mental and Behavioral Health Emergencies

Publication Number: 1579.602

Jennifer A.. Hoffmann, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Ashley A. Foster, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Polina Krass, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Sideeq Ibrahim, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Sara Huston, Ann & Robert H. Lurie Children's Hospital of Chicago, Durham, NC, United States; Lynn Babcock, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Rachel Cafferty, University of Colorado School of Medicine, Aurora, CO, United States; Susan Duffy, Hasbro Children's Hospital at Rhode Island Hospital, Brown University, Providence, RI, United States; Bijan W. Ketabchi, Children's Hospital of Philadelphia, Wynnewood, PA, United States; Kevin Li, Robert Larner, M.D., College of Medicine at the University of Vermont, Winooski, VT, United States; Bradford H. McClain, Cincinnati Children's Hospital and Medical Center, Burlington, KY, United States; Paul Mullan, Children's Hospital of The King's Daughters, Norfolk, VA, United States; Shilpa J.. Patel, Children's National Hospital, Bethesda, MD, United States; Raymond Pitetti, UPMC Childrens Hospital of Pittsburgh, Bridgeville, PA, United States; Steven C. Rogers, University of Connecticut School of Medicine, Hartford, CT, United States; Mohsen Saidinejad, University of California, Los Angeles David Geffen School of Medicine, Torrance, CA, United States; Neil G. Uspal, University of Washington School of Medicine, Seattle, WA, United States; Ambrose H. Wong, New York University Grossman School of Medicine, New York, NY, United States; Jacqueline Grupp-Phelan, University of California, San Francisco, San Rafael, CA, United States

Background: Emergency department utilization by children experiencing mental and behavioral health crises has increased significantly over the last decade. Despite the critical role of the emergency department in providing mental and behavioral health care, many gaps exist in the evidence base to inform best practices. A consensus-based research agenda can guide investigators and funders to prioritize research questions that urgently need to be answered to advance the provision of high-quality, patient- and family-centered care for this population.

Objective: To identify high priority research questions for the acute emergency care of children with mental and behavioral health conditions and develop a consensus-based research agenda, informed by input from patient and family representatives, multidisciplinary clinicians, and research funders.

Design/Methods: Proposed research priorities related to acute emergency care of children with mental and behavioral health conditions were conceived by multidisciplinary members of the Pediatric Emergency Care Applied Research Network (PECARN) Mental Health Working Group, informed by review of the literature. Then, an expert panel participated in the modified Delphi method to modify, add to, and rate proposed research priorities across three survey rounds. Research priorities were first rated on a 9-point Likert scale by overall priority, followed by rating along three specific domains (need and urgency, research impact, and family centeredness) which enabled sorting identified research priorities into three tiers. Top tier priorities had a median rating of ≥7 for all 3 domains and median of >7 in at least 2 of 3 domains.

Results: Twenty-three expert partners included caregivers and young adults with lived experience related to emergency care for mental and behavioral health conditions, multidisciplinary clinicians with nationally recognized expertise and experience caring for youth with mental and behavioral health conditions, and program officers/research funders. The modified Delphi process generated 51 consensus-based research priorities, of which 31 were classified in the top tier (Figure 1). Top tier research priorities encompassed aspects of prehospital care, general emergency care and boarding, suicide prevention, management of acute agitation, and post-discharge follow-up care (Table 1).

Conclusion(s): This consensus-based research agenda, which integrates diverse perspectives, will inform future directions for research to improve acute emergency care for children with mental and behavioral health conditions.

Figure 1. Modified Delphi Process to Develop Research Agenda


Table 1. Top Tier Research Priorities for the Acute Emergency Care of Children with Mental and Behavioral Health Emergencies


Table 1 (Continued). Top Tier Research Priorities for the Acute Emergency Care of Children with Mental and Behavioral Health Emergencies