About one in five children will have a mental health or emotional issue during childhood. In 2017, Dell Children's Medical Center of Central Texas had about 1,700 behavioral health cases in the hospital's emergency department (ED) and roughly 11,000 cases in a freestanding outpatient treatment facility for behavioral health related issues. In addition, the hospital's emergency department saw about 200 patients who died from suicide or suicide attempts.
While the freestanding treatment facility fulfilled outpatient needs, it didn't always have the capacity to asses if a patient was having a medical issue. "We were moving patients who had medical issues from the behavioral health facility to our acute care facility—it was affecting families," says Brandy Hart, M.S., LPC-S, ACHE, chief administrative officer, Dell Children's. "This added to the cost of care, and it was not an ideal health care model."
At the 2019 Quality and Safety in Children's Health Conference, Hart and her colleague, Liz Stacy, CCLS, MBA, project analyst at Dell Children's, outlined the challenges of integrating two separate entities. The organization wanted to create an overall integrated care model so patients presenting with mental health needs at the freestanding facility had easier access to acute care if needed.
The organization built an annex to the main hospital with 24 in-patient beds for patients ages 6 to 17. The annex also serves as a separate entry point from the ED for behavioral health patients, so they can be in immediate contact with a behavioral health professional to determine if they need to be admitted or if they need outpatient treatment.
The annex also has 24-hour coverage with a social worker and a nurse, and a 24-hour triage line means parents and community providers can call to speak with a behavioral health professional, ask questions, understand where to they should go, come directly to the annex if possible, or be directed to ED.
The result, Hart says, is integrated care that's stigma free. "Parents are more comfortable saying, ‘Sorry, my kid missed a week of school—she was in the children's hospital,' instead of saying, ‘She was in a mental health treatment facility,'" Hart says. "We hope that stigma goes away, but it exists."
Since opening the annex in May 2018, Dell Children's has seen the same volume in ED visits the hospital saw for the entire year of 2017. "If you build it they will come," Hart says. "We have growing population of patients who need this care."
