title: Pediatric mental health concerns in the emergency department: caregiver and youth perceptions and expectations.
abstract: OBJECTIVE
  The main purpose of this research was to identify the perceived mental health (MH) concerns of caregivers and youths who present to the emergency department (ED) for MH services. The concordance between caregiver and youth perceptions and clinician ratings of MH concerns were evaluated. Expectations for the visit and perceived stressors that triggered the event are described.
  
  
  METHODS
  This study consisted of 241 youths accompanied by caregivers presenting to the ED for MH concerns requiring crisis intervention services. The Caregiver Perception Survey and Youth Perception Survey were completed. These surveys were designed to identify the caregivers' and youths' main concerns and perceived stressors, as well as their expectations in coming to the pediatric ED. A chi analysis was conducted to determine the percentage of agreement of reported MH concerns between groups (youth, caregiver, and clinician), and kappa statistics are reported.
  
  
  RESULTS
  Caregivers' and youths' top 5 concerns were suicide ideation, depression or mood, suicidal attempt, anxiety, and self-injury. The top 3 stresses identified by both youths and their caregivers were school, issues with parents, and problems with friends/peers. The top 3 expectations that were noted by caregivers were help/guidance for child, assessment/ evaluation/diagnosis, and health care professional resources. Concordance rates between caregivers and youths for the top 5 concerns ranged from 39.4% to 80.6%. Concordance rates between clinician rating of concerns (as requiring some or immediate action) and caregiver concerns ranged from 18.4% to 45.2%. Concordance rates between clinician and youth ranged from 11.1% to 59.4%.
  
  
  CONCLUSIONS
  The top 5 caregivers and youths' main concerns for coming to the ED were similar. However, concordance between perceived concern and clinician assessment is low. Caregivers' expectations for coming to the ED highlight their lack of knowledge of referral procedures and MH services.
authors.affiliation: Mental Health Patient Service Unit, Children's Hospital of Eastern Ontario, Ontario, Canada. cloutier@cheo.on.ca
authors.forename: Paula
authors.initials: P
authors.lastname: Cloutier
authors.forename: Allison
authors.initials: A
authors.lastname: Kennedy
authors.forename: Heather
authors.initials: H
authors.lastname: Maysenhoelder
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Glennie
authors.forename: Mario
authors.initials: M
authors.lastname: Cappelli
authors.forename: Clare
authors.initials: C
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D019955:Conduct Disorder / Q000453:epidemiology / Q000523:psychology; D003419:Crisis Intervention / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008605:Mental Health Services / Q000600:supply & distribution; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010290:Parents / Q000523:psychology; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D000297:Psychology, Adolescent; D002666:Psychology, Child; D013315:Stress, Psychological / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014754:Violence