21.1 Building Remote Bridges: Mental Health Care Coordination in the COVID-19 Pandemic

Abstract

We will describe the impact of a pilot clinical program providing time-limited therapeutic and case management support for patients discharging from the hospital. The Community Advocacy, Resource, and Engagement (CARE) Team is a 30-day bridge service (with the option to extend if indicated) offering care coordination, short-term therapy and medication management, phone coaching, and community advocacy for patients identified as being high risk for readmission. A sample of 98 patients were referred to the CARE Team. Data were obtained via a semi-structured phone survey and chart review. A primary outcome measure was the number of emergency department (ED) visits and mental health hospitalizations in the 60 days post–CARE Team involvement; due to the absence of a control group, we compared these events with the 60-day period before CARE Team involvement for the same population. Other outcome measures were family satisfaction and linkage to longer term treatment. The IRB at Seattle Children’s Hospital approved this study. The average age was 13 years (range = 6-17 years) and the majority of patients lived with a caregiver, although a few were in state custody. This sample presented with a broad range of diagnoses. All CARE Team patients were linked with ongoing mental health treatment; the average patient and family satisfaction rating was 4.1 on a scale of 1 to 5. There was a 31% decrease in the number of mental health hospitalizations in the 60 days post–CARE Team compared to 60 days pre-index hospitalization (from 29 to 20). We also noticed a 52% decrease in ED visits for mental health reasons not resulting in hospitalization (from 33 to 16). The average duration of services was 6.4 weeks; the COVID-19 pandemic impacted availability of services, thus extending many patients’ involvement with the team. We saw a decrease in the number of hospitalizations and ED visits after patients discharged from the CARE Team compared to before their linkage with the team. Families were satisfied with the service. Given recent trends of increasing suicidality and hospitalizations in youth, there is an enormous need for novel clinical services like the CARE Team to provide case management and therapeutic support as patients transition out of the hospital.