Telehealth Increases Access to Care for Children Dealing with Suicidality, Depression, and Anxiety in Rural Emergency Departments.

Abstract

Background: Targeted research efforts in implementation and evaluation of telemental health care for U.S. youth are needed to increase accessibility to care. Before telehealth, children and families may wait weeks for psychiatric evaluation. Introduction: Increasing numbers of pediatric patients are reporting the need for mental health care when they present to region's rural emergency departments (EDs). Outcomes of telemental health services were evaluated, with a focus on treatment throughput and referral. Materials and Methods: Observational 18-month program evaluation of outcomes for children age <18 years (N = 87) who received physical and mental health assessment by an ED physician. Children who subsequently received a mental health diagnosis were treated by a psychiatrist via telemental health visits (September 2017-May 2019) in 4 rural EDs. Results: The majority of children (ages 5-17) presented with depression- or anxiety-related disorders (49%) or suicidal ideation/attempt or self-harm (46%), with substance abuse accounting for 5% of cases. Mean ED wait times were 29 min [95% CI: 6-52 min] for children admitted to inpatient (IP) care compared with 33 min [95% CI: 22-43 min] for those discharged to outpatient (OP) care. Mean length of stay (LOS) of 8 h 56 min [95% CI: 166-906 min] was observed for children admitted to IP care compared with mean LOS of 6 h 58 min [95% CI: 382-454 min] for those discharged to OP care (p = 0.072). For suicidality cases, children who were subsequently admitted to IP care experienced a significantly longer mean LOS of 12 h 30 min [95% CI: 279-1221 min] compared with a mean LOS of 7 h 13 min [95% CI: 346-520 min; p = 0.015] for children discharged to OP care. Mean total payor reimbursements were significantly lower than actual ED costs (p < 0.001). Discussion: ED wait times and LOS were lengthy overall. Future evaluation of an evidence-based peds mental health triage screening tool is needed to support rural ED providers in peds mental health treatment. Conclusion: Additional resources and strategic policy supports are needed to bridge the mental health care treatment gap for rural children to address critical prevention, screening, and reimbursement needs.