WILMINGTON, Del. (July 27, 2021) – More than one-fifth (21.5%) of teenage patients screened for mental health concerns in the Emergency Department (ED) at Nemours/Alfred I. duPont Hospital for Children reported symptoms of severe depression, and 7.8% reported suicidal thoughts in the pandemic’s first 12 months. The number of patients over age 12 seen in the ED who reported current suicidal thoughts, and then required direct observation, rose from 0.36% in the 12 months preceding the pandemic to 1.69% in the first 12 months after the pandemic began.
The findings emerged from a youth mental health screening program in Nemours’ ED in Wilmington, Del. The results were presented today at the National Alliance on Mental Illness Virtual National Convention 2021.
“The biggest surprise was such a high number of positive screens, indicating mental health concerns, for patients presenting with complaints other than behavioral health” said Jennifer Cooper, BSN, RN, SANE‑P, Forensic Nurse Coordinator in the ED of Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., who presented the findings. Forensic nurses provide specialized care for patients with health consequences of victimization or violence. “We knew the number of behavioral health patients was rising during the pandemic, but the screening program showed just how much it had increased. Adolescent behavioral health is a growing concern, and thus the need for vigilance is even greater.”
Of the 2,743 teenage patients Nemours screened in the ED from March to December 2020, 770 reported signs of moderate or severe depression, and 215 reported current suicidal thoughts.
Because the screening was conducted in the ED, staff were able to identify teens experiencing serious mental health challenges who may have been missed otherwise, particularly if their reason for visiting the ED was not related to mental health.
The American Academy of Pediatrics and the Committee on Pediatric Emergency Medicine support using specialized instruments to identify child and adolescent mental health issues during ED visits. However, a 2017 analysis found that these are not yet standard components of clinical assessments in EDs. In a Canadian study, of those aged 11 and older who died by suicide, 30% visited the ED with other complaints – not mental health-related – in the month before their death. Moreover, EDs provide nearly half of all hospital-associated medical care in the U.S., so they can complement primary care as a very effective settings for youth mental health screening.
“Establishing an effective screening protocol can be tough. If it proves too complex for staff to implement, it will be underutilized, and the full benefit will not be realized,” said Cooper. “With full support from ED leadership and clinical staff, we identified and eliminated bumps in the process. We reduced the frequency of EHR reminders to use the screener, refined our criteria for excluding patients who were inappropriate for this screener, and automatically added Counseling and Social Work recommendations in discharge papers for those we did screen.”
As of December 2020, Nemours reached a 62.3% mental health screening rate among all eligible patients, regardless of their reason for coming to the ED. Before the current program, ED staff had screened on average just 1.77% of eligible patients. Teens completed the screener themselves on a tablet, which many said provided autonomy and privacy to respond to the questions.
Program staff identified the following key takeaways:
Future plans include expanding the screening to younger patients, administering it in Spanish, revising it to accommodate lower reading comprehension levels, working to remove stigma around mental health, and providing a comprehensive wellness plan.
The project was funded in part by a three-year grant from the federal Substance Abuse and Mental Health Services Administration.
About Nemours Children’s Health
Nemours Children’s Health is one of the nation’s largest multistate pediatric health systems, including two free-standing children's hospitals and a network of nearly 80 primary and specialty care practices across five states. Nemours seeks to transform the health of children by adopting a holistic health model that utilizes innovative, safe, and high quality care, while also caring for the health of the whole child beyond medicine. Nemours also powers the world’s most-visited website for information on the health of children and teens, KidsHealth.org.
The Nemours Foundation, established through the legacy and philanthropy of Alfred I. duPont, provides pediatric clinical care, research, education, advocacy, and prevention programs to the children, families and communities it serves.
Presentation: “Effectiveness of Youth Mental Health Screening in the ED”
Date/Time: Tuesday, July 27, 3:40 -4:40 ET
Conference: National Alliance on Mental Illness Virtual National Convention 2021
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