Screening for mental health issues in a pediatric ED

Children's Hospital Los Angeles

In a study to be published on Oct. 1 by the journal Pediatric Emergency Care, investigators at Children's Hospital Los Angeles piloted a brief mental health screening tool to be used with patients accessing the emergency department for medical complaints who might be at risk for mental health problems. Of the 992 patients studied, nearly half (47.5%) responded "yes" to questions about substance abuse, traumatic exposure or behavioral symptoms such as depression and anxiety.

In the U. S., 1 in 10 children and adolescents suffer from mental illness, yet only 1 in 5 receive mental health services. Many undiagnosed mental health conditions can lead to chronic medical conditions that interfere with a child's normal development and functioning.

"Based on recommendations from organizations, literature and research, it is becoming clear that identifying mental health needs is part of quality medical care," said Alan L. Nager, MD, MHA, director of Emergency and Transport Medicine at Children's Hospital Los Angeles and first author on the study. "The emergency department is the ideal place for that assessment to occur." Nager is also professor of Clinical Pediatrics at the Keck School of Medicine of USC.

This retrospective study was based on a previous quality improvement project that assessed mental health issues among English-speaking patients, 12 years of age or older. Interviews were conducted by physicians in the privacy of the patient's room, without parent or caregiver present. Patients were asked to answer 11 yes/no questions that covered a range of mental health issues including hyperactivity, exposure to domestic violence, drug and alcohol use, bullying and thoughts of suicide.

"By embedding mental health screening in the emergency department, we are making it part of our health care culture -- reducing the stigma associated with mental health problems and providing the opportunity for early identification and treatment for all children," said Jeffrey I. Gold, PhD, director of the Children's Outcomes, Research and Evaluation program at CHLA and an author on the study. Gold is also an associate professor in Anesthesiology and Pediatrics at the Keck School of Medicine of USC.

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Additional authors include Phung K. Pham and Daniel N. Grajower, both of CHLA.

About Children's Hospital Los Angeles

Children's Hospital Los Angeles has been named the best children's hospital in California and among the top 10 in the nation for clinical excellence with its selection to the prestigious U.S. News & World Report Honor Roll. Children's Hospital is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States. Children's Hospital is also one of America's premier teaching hospitals through its affiliation since 1932 with the Keck School of Medicine of the University of Southern California. For more information, visit CHLA.org. Follow us on Twitter, Facebook, YouTube and LinkedIn, or visit our blog at http://researchlablog.org/.