School-Based Psychiatric Mental Health Nurse Practitioners to Decrease Inappropriate Psychiatric Pediatric Emergency Rooms Presentations.

Abstract

An alarming number of children are being referred to pediatric emergency rooms for disruptive behavior disorders (DBDs) such as attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorders. Although presenting symptoms of an exacerbation of disruptive behaviors may be urgent, often they do not require emergency care and could have been efficiently handled through outpatient care. Inappropriate emergency room (ER) referrals have been linked to inadequate school, family, or self-referrals. This article proposes using psychiatric mental health nurse practitioners, known in some states as advanced practice registered nurses, in school-based mental health programs as an intervention with the greatest potential to decrease disparities in access to child psychiatric health care and to offer the psychoeducation and support necessary to prevent inappropriate ER presentations for DBDs.