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A Research Agenda for Acute Pediatric Mental and Behavioral Health Emergencies
Jennifer A Hoffmann1, Ashley A Foster2, Polina Krass3
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
This study outlines a research agenda for pediatric mental health emergencies. It prioritizes improving care for children at risk of harm in emergency departments and pre-hospital settings.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Health Services Research
Background:
- Emergency departments (EDs) face increasing challenges in managing children with mental and behavioral health conditions.
- There is a critical need for evidence-based research to guide the care of these vulnerable youth.
- Existing research priorities require consensus and refinement to address current gaps.
Purpose of the Study:
- To establish a consensus-based research agenda for the emergency care of children with mental and behavioral health conditions.
- To identify high-priority research questions through expert consensus.
- To inform future research directions and improve clinical practice.
Main Methods:
- A modified Delphi method was employed with 23 expert partners, including parents and clinicians.
- Initial research priorities were informed by a literature review and then modified, added to, and rated by experts over three survey rounds.
- Consensus was defined by specific median ratings on priority, need, urgency, research impact, and family-centeredness.
Main Results:
- Fifty-one research priorities reached consensus, with 31 identified as top-tier.
- Key areas include out-of-hospital care, general ED care, management of acute agitation, suicide prevention, and post-discharge follow-up.
- Expert panel composition ensured diverse perspectives, including lived experience.
Conclusions:
- A consensus-driven research agenda has been developed to guide future studies in pediatric emergency mental health.
- This agenda highlights the need for improved identification and management strategies for children at risk of harm.
- The findings emphasize the importance of integrated care across out-of-hospital and ED settings.
Study Objective:
To identify high-priority research questions related to emergency care of children with mental and behavioral health conditions and develop a consensus-based research agenda.
Methods:
We recruited expert partners to participate in a modified Delphi method to develop a consensus-based research agenda. The Pediatric Emergency Care Applied Research Network Mental Health Working Group formulated initial research priorities, informed by literature review. Expert partners modified, added to, and rated proposed research priorities on a 9-point scale across 3 survey rounds. Ratings assessed overall priority, followed by need and urgency, research impact, and family centeredness. Top tier priorities had a median of at least 7 for all 3 domains and a median over 7 in at least 2 domains.
Results:
The 23 expert partners included 4 parents/caregivers and 1 young adult with lived experience, 9 physicians with various training backgrounds, 3 nurses, 3 social workers, 2 out-of-hospital clinicians, and 1 program officer. Of 76 initial research priorities, 41 were dropped and 16 were newly proposed; the expert panel reached consensus on 51 research priorities. Thirty-one top tier research priorities encompassed aspects of out-of-hospital care (eg, training, novel response models), general emergency care and boarding (eg, brief interventions), management of acute agitation (eg, effectiveness of de-escalation methods and medications), suicide prevention (eg, effectiveness of safety planning), and optimal postdischarge follow-up care.
Conclusion:
This consensus-based research agenda, which integrates diverse perspectives, informs the need for research to improve identification and management of children at risk of harming themselves or others in the out-of-hospital and emergency department settings.
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