Dartmouth study offers new details on pediatric mental health boarding

September 25, 2020

A Dartmouth-led study, published in the journal Pediatrics, offers new details about pediatric mental health boarding in emergency departments across the country, a problem that has steadily increased in the last 10 years and been made worse by a shortage of psychiatric resources.

Boarding refers to the practice of admitting children and adolescents--who are in need of inpatient mental health treatment--to emergency departments or inpatient medical units while they wait for a psychiatric bed to become available in the hospital.

Behavioral and mental health disorders are the most common and costly chronic diseases that affect children and adolescents. Approximately one in six U.S. youths has a behavioral or mental health condition, and treatment costs for these disorders are estimated to exceed $13 billion annually. Yet, 50 to 70 percent of children who have treatable behavioral and mental health conditions don't receive care from behavioral and mental health professionals.

"Although mental health boarding is widely recognized as a major health system challenge, its processes, outcomes, and risk factors had not previously been systematically reviewed," explains co-author Fiona McEnany, MPH '19, a PhD student at Dartmouth's Guarini School of Graduate and Advanced Studies who contributed to the research project as part of her Master of Public Health program study at The Dartmouth Institute for Health Policy and Clinical Practice. "Our goal was to characterize the prevalence of pediatric mental health boarding and to identify factors among patients and hospitals that increase the likelihood of this care process."

To this end, the research team conducted a comprehensive review of 222 studies to describe frequencies, durations, processes, outcomes, and/or risk factors associated with youth mental health boarding in the U.S. Of the 11 studies that met their criteria for inclusion, the majority were retrospective analyses conducted at individual hospitals. Of these single-center studies, all were performed at children's hospitals or pediatric emergency departments in urban or suburban areas--with study sample sizes ranging from 27 to 44,328 patient participants.

The investigators found that among young patients needing inpatient psychiatric care, 23 to 58 percent were boarded in hospital emergency departments while 26 to 49 percent were boarded on inpatient medical units. Boarding durations ranged on average from five to 41 hours in emergency departments and two to three days in inpatient units. Key risk factors for children included being younger in age, having suicidal or homicidal thoughts, and seeking care at hospitals during non-summer months.

In sum, the research team found that pediatric mental health boarding is prevalent and understudied. "It's a vital issue in youth mental healthcare today, experienced by at least 40,000 to 66,000 youth admitted to hospitals each year," says The Dartmouth Institute's JoAnna Leyenaar, MD, PhD, MPH, an associate professor of pediatrics and of health policy and clinical practice at Dartmouth's Geisel School of Medicine, and a co-author on the study. "More research that represents a diversity of hospital types and geographical regions is needed, so that we can inform clinical interventions and healthcare policies to better support youth who board each day at hospitals across the country."
-end-
The Dartmouth Institute for Health Policy and Clinical Practice is a world leader in studying and advancing models for disruptive change in healthcare delivery. The work of Dartmouth Institute faculty and researchers includes developing the concept of shared decision-making between patients and healthcare professionals, creating the model for Accountable Care Organizations (ACOs), and introducing the game-changing concept that more healthcare is not necessarily better care.

The Geisel School of Medicine at Dartmouth

Related Children Articles from Brightsurf:

Black and Hispanic children in the US have more severe eczema than white children
A presentation at this year's virtual American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting reveals the disparities that exist for Black and Hispanic children when it comes to Atopic Dermatitis (AD), commonly known as eczema.

Black children with cancer three times less likely to receive proton radiotherapy than White children
A retrospective analysis led by investigators from Brigham and Women's Hospital has found racial disparities in the use of the therapy for patients enrolled in trials.

The Lancet Child & Adolescent Health: First Europe-wide study of children confirms COVID-19 predominately causes mild disease in children and fatalities are very rare
Children with COVID-19 generally experience a mild disease and fatalities are very rare, according to a study of 582 patients from across Europe published today in The Lancet Child & Adolescent Health journal.

Children not immune to coronavirus; new study from pandemic epicenter describes severe COVID-19 response in children
- While most children infected with the novel coronavirus have mild symptoms, a subset requires hospitalization and a small number require intensive care.

How many children is enough?
Most Russians would like to have two children: a boy and a girl.

Preterm children have similar temperament to children who were institutionally deprived
A child's temperament is affected by the early stages of their life.

Only-children more likely to be obese than children with siblings
Families with multiple children tend to make more healthy eating decisions than families with a single child.

Children living in countryside outperform children living in metropolitan area in motor skills
Residential density is related to children's motor skills, engagement in outdoor play and organised sports. that Finnish children living in the countryside spent more time outdoors and had better motor skills than their age peers in the metropolitan area.

Hispanic and black children more likely to miss school due to eczema than white children
In a study that highlights racial disparities in the everyday impact of eczema, new research shows Hispanic and black children are more likely than white children to miss school due to the chronic skin disease.

Children, their parents, and health professionals often underestimate children's higher weight status
More than half of parents underestimated their children's classification as overweight or obese -- children themselves and health professionals also share this misperception, according to new research being presented at this year's European Congress on Obesity (ECO) in Glasgow, UK (April 28-May 1).

Read More: Children News and Children Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.