Developing a safety plan is also essential, Dr. Wharff pointed out. To make one, facilitators ask patients what they would need to feel safe going home; they ask parents what they would need. The facilitators work with families to plan a personalized set of measures—which might include locking up medications or guns, and getting rid of sharp knives—to avert a potential crisis.

Open Pediatrics

After Dr. Wharff published papers about her work, other hospitals became interested in learning about it. In response, Dr. Wharff and her team developed an online training program that is available to other facilities through Boston’s Children’s platform, Open Pediatrics. At the moment, she is working with four primary care practices across Massachusetts to test a pilot program for doctors in primary care. She should be ready to disseminate the results in a year. 

“We found that doing this intervention led to a huge reduction in psychiatric boarders,” Dr. Wharff said.

Thirty percent of the kids who got it still went on to the inpatient unit, but according to Dr. Wharff, the intervention had value for them too: “The patients and their parents had already done the work of communicating,” she explained. “They’d learned about each other’s narrative; they’d learned and developed some skills.” 

Jason Levy, MD, clinical chief of Boston Children’s Hospital’s ED said that implementation of the new program is still ongoing. “We have not yet fully implemented the system universally and don’t have data yet on effectiveness,” Dr Levy reported.

However, the trial has found that parents were extremely satisfied. “Most parents want to help their kids, so they want the tools to do that,” said Dr. Wharff. “In one case, a father who was a neurologist called me and said, ‘This is the best treatment our family has ever had.’”

Maura Kelly, a health writer, is a special contributor to Annals of Emergency Medicine.

Reference

1. Nordstrom K, Berlin JS, Nash SS, et al. Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. West J Emerg Med. 2019;20(5):690-695.
2. McEnany FB, Ojugbele O, Doherty JR, et al. Pediatric mental health boarding. Pediatrics. 2020;146(4):e20201174.
3. Malas N, Hindman D, Mroczkowski M, et al. Updates in pediatric boarding: a review of National Pediatric Boarding Consensus Panel recommendations. Psychiatric Times. https://www.psychiatrictimes.com/view/updates-in-pediatric-boarding-a-review-of-national-pediatric-boarding-consensus-panel-recommendations Published September 25, 2023. Accessed October 31, 2024.