Navigator Emergency Department Diversion Models for Non-Urgent Mental Health Concerns

Presenter

Mary Acri, Ph.D. 
Division of Services and Intervention Research  

Goal

The purpose of this concept is to support research examining the effectiveness, implementation, adoption and scale-up of patient navigation emergency department (ED) diversion models for youth with non-urgent mental health concerns and their caregivers. 

Rationale

Up to 40% of ED visits by youth are for non-urgent mental health concerns such as symptoms of depression, anxiety, and maladaptive behaviors. A non-urgent ED visit is defined as one in which a delay of several hours would not increase the potential for an adverse outcome to occur. Commonly, caregivers who are overwhelmed or unsure about how to address their child’s mental health needs utilize the ED as a safety net; additionally, EDs are widely perceived as a primary point of entry into mental health services, circumventing barriers due to a congested mental health service system. However, non-urgent ED visits are problematic because: (1) youth are unlikely to see a mental health professional or receive evidence-based mental health services, (2) caregivers are unlikely to receive emotional support, information about their child’s mental health and treatment options, and other family strengthening supports, and, (3) the family is unlikely to be linked to mental health services beyond a passive referral or have barriers to help seeking addressed in a meaningful way.

Patient navigation, an evidence-based practice that guides individuals through the health care system, is a promising approach to support caregivers and connect youth to needed mental health services. However, there is limited knowledge regarding the effectiveness and implementation of patient navigation models for children and adolescents with non-urgent mental health concerns and their caregivers. Additionally, there is a considerable gap in ED diversion models that aim to strengthen the family and facilitate service utilization.

The proposed concept would support clinical trials that pilot and fully test the effectiveness of patient navigation ED diversion models that (a) triage youth with varying mental health acuity and provide a level of risk/corresponding service response, (b) provide family strengthening supports to caregivers (e.g., emotional support, mental health knowledge) and facilitate engagement in community mental health services (c) utilize novel technologies to monitor/track symptoms, engagement in community mental health services, and ED utilization over time, and (d) advance understanding about how, why and for whom these models may work NIMH encourages practice partner approaches with the hopes of informing study design and ensuring that . findings that can be readily put into practice. This concept aligns with Goal 4 of the NIMH Strategic Plan for Research that calls for developing innovative service delivery models and expediting the adoption, sustained implementation, and continuous improvement of evidence-based mental health services.