Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-12-2018

Graduate Advisor

Laura Kuensting

Committee

Allison Brauch

Sally Haywood

Abstract

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization with a mental health complaint or diagnosis was selected.

Results. Twenty-four subjects (N=24) were enrolled with the three most common diagnoses being Major Depressive Disorder (45.8%, n = 11), Attention Deficit Hyperactivity Disorder (37.5%, n = 9), and Post-Traumatic Stress Disorder (25%, n = 6). The pre-YERE rate of ED and inpatient admissions was 2.96, which decreased to 2.00 post-YERE. In addition, ED visits decreased by 42.55% and inpatient psychiatric admissions decreased by 12.5% post-YERE enrollment. Those with Medicaid (71%) were more likely to be enrolled in the program. Zip code was found to be a predictor of admissions post-YERE enrollment (p < .001).

Implications for Practice. The YERE program reduced ED and inpatient psychiatric admissions for youth. Zip codes could be used to predict areas of future program focus. More study is needed to determine why Medicaid patients were more likely to be enrolled.

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