title: Connections to outpatient mental health care of youths with repeat emergency department visits for psychiatric crises.
abstract: OBJECTIVE
  This study examined connections to outpatient mental health care before and between an initial and subsequent pediatric psychiatric emergency department visit.
  
  
  METHODS
  Data for an eight-year period were obtained from the Pediatric Psychiatry Emergency Evaluation Form (PPEEF), which is completed by a child psychiatrist. A total of 338 youths were identified who returned to the emergency department of an urban general hospital within six months of an index visit. Logistic regression models were used to examine the association between having a connection to outpatient mental health care and repeated use of the emergency department.
  
  
  RESULTS
  Behavior problems were the presenting complaint for more than 50% of youths at both the index and second visits. Sixty-five percent of youths reported a connection to an outpatient mental health provider at both visits; 9% did not identify a provider at either visit. Eight percent of the youths who reported a connection to community care at their first visit reported no such connection at their second visit. At the second visit, the likelihood of reporting a connection with outpatient care was nearly five times higher among youths who reported such a connection at the index visit.
  
  
  CONCLUSIONS
  Continued use of the emergency department despite a connection with outpatient mental health care raises questions about the views of families and providers about the need for emergency services. More research is needed to better understand patterns of care seeking in order to fully inform policy and program development.
authors.affiliation: Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA. efrosch@jhmi.edu
authors.forename: Emily
authors.initials: E
authors.lastname: Frosch
authors.forename: Susan
authors.initials: S
authors.lastname: dosReis
authors.forename: Kate
authors.initials: K
authors.lastname: Maloney
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D001008:Anxiety Disorders / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D015142:Baltimore; D002648:Child; D002675:Child, Preschool; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003419:Crisis Intervention / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D019964:Mood Disorders / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000706:statistics & numerical data; D012307:Risk Factors; D055502:Secondary Prevention; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data