ER visits for children in crisis up 20 percent

The number of Medicaid-insured children treated in Connecticut emergency rooms for behavioral health crises rose 20 percent between 2014 and 2016, mirroring a national trend — despite efforts to provide non-ER treatments, according to a study released Thursday.

Connecticut ERs recorded 14,448 Medicaid-insured youth visits in 2016, compared to 12,000 in 2014, according to a study of Medicaid-eligible patients ages 18 and younger commissioned by the Child Health and Development Institute of Connecticut.

Most of the children who go to emergency rooms with behavioral health issues go to one of five hospitals, according to data collected by consultant Beacon Health Options, which manages behavioral health care for the state’s Medicaid population.

Connecticut Children’s Medical Center in Hartford saw the most behavioral health-related ER visits, with 3,962 visits by Medicaid-insured youth in 2016. Yale New Haven Hospital and Yale New Haven Children’s Hospital had a combined total of 2,263 visits, followed by St. Mary’s Hospital in Waterbury with 1,185 and William Backus Hospital in Norwich with 1,203.

Charlotte Hungerford in Torrington saw 263 visits; Middlesex Hospital in Middletown saw 332; and Griffin Hospital in Derby saw 111 visits.

After those 2016 ER visits, the study reported, 10.4 percent of youths were readmitted to the ER within seven days, and 25.6 percent were re-admitted within 30 days. The study’s authors said this indicates that youth and/or family needs were not met at the visit or by the services utilized after discharge.

Hospital emergency departments often are illequipped to handle children experiencing behavioral health crises. Those children may benefit more from treatment at community mental health centers, schools or a pediatrician’s office, the report’s authors wrote.

“Emergency departments are not really set up from physical standpoint or from a staffing standpoint to be a primary care behavioral health treatment center,” said Jeff Vanderploeg, president and CEO of the Child Health and Development Institute.

Many of the children did not have a follow-up appointment within a month of their initial trip to the emergency room, the study reported.

The report’s authors reviewed several studies of both nationwide trends and the data from individual hospitals, including one that showed emergency room visits for publicly insured patients under age 18 experiencing psychiatric problems rose 26 percent from 2001 to 2010.

A 2014 national study cited in the report showed the numbers of psychiatric emergency room visits for children covered by private insurance declined during the same period.

In Connecticut, the 2012 mass shooting at Sandy Hook Elementary School prompted state officials to try to reduce behavioral health emergency room visits with initiatives to increase the number of crisis-- stabilization beds, create Behavioral Health Assessment Centers and redirect children with autism spectrum disorders to specialized services.

The report’s authors said some of those efforts have been effective, singling out the state’s Mobile Crisis Intervention Service hotline as a “critical alternative” to the ER that parents, guardians and teachers can call to request a clinician who will treat the child at their home or school.

“We have one of the best behavioral health systems for children in the country ... and we’re still seeing a large number of children showing up to emergency departments for treatment,” Vanderploeg said.

The report said nearly 1,300 Medicaid-insured children in 2016 were “stuck” in the emergency room after a behavioral health crisis, staying in the hospital for days or weeks before they were discharged, according to the data.

And about 35 percent of those children did not have a follow-up appointment to see a behavioral or mental health professional in the month after they went to the emergency room. Vanderploeg said that number could indicate poverty, lack of transportation or poor coordination between behavioral health providers.

A CHDI working group that produced the report concluded that the state should try to alleviate pressure on emergency rooms by promoting collaboration between the hospitals, the state’s mobile crisis program and schools, and try to promote follow-up care at community health organizations for children who have been to the emergency room.

“If someone is coming to the ED and the questions are really about how to manage or treat the individual in an ongoing way ... the staff are not necessarily trained or focused on addressing those questions,” said Michael Hoge, director of Yale Behavioral Health at the Yale Department of Psychiatry and a consultant on the working group. “It raised the question of where else they would go.”

Family members of children with behavioral health concerns said they relied on emergency rooms when the child’s behavior was out of control or when the child had suicidal thoughts, often to get a diagnosis or guidance about how to cope, according to the report.