Utilization of mental health services among urban youth with emotional and behavioral disorders: racial/ethnic differences in emergency department and outpatient visits

Abstract

Rising rates of pediatric emergency department (ED) visits for psychiatric reasons pose a significant burden for healthcare systems in the United States. Utilization of outpatient mental health treatment by youth and their families may prevent some behavioral health crises requiring emergency services, as well as non-urgent ED visits where emergency care is not necessary. This study utilized de-identified electronic health records to examine seasonal and secular patterns in both psychiatric ED presentation and outpatient mental health care utilization among youth, as well as the association of outpatient mental health care with psychiatric ED visits. Racial/ethnic differences in service utilization were also examined. The study sample consisted of 25,545 school-aged youth who were diagnosed with an emotional or behavioral disorder and received services at Boston Medical Center (BMC) between 2009 and 2018. Results indicate significant seasonal patterns in both psychiatric ED visits and outpatient mental healthcare that parallel the school calendar, with more youth receiving services during the school year than in the summer. Mental healthcare among youth of color was more closely aligned with the school calendar than among White youth, suggesting that schools may be more instrumental for the referral of youth of color into mental healthcare than for White youth. In addition, youth who accessed outpatient care were at decreased risk for psychiatric ED presentation as compared to youth who had not accessed outpatient services. Longer duration of outpatient treatment and a greater number of visits were associated with increased risk for ED presentation, whereas greater frequency of visits was associated with decreased risk for ED presentation. Findings suggest that preventive outreach for youth and families may be particularly helpful in late summer and early winter, prior to significant increases in both psychiatric ED visits and outpatient service use.