Swathi Khrishna sakris2@emory.edu

Sonali Bora Sonali.bora@choa.org

Many primary care providers are on the front lines of fielding questions and identifying symptoms of psychiatric illness in children and adolescents in the community setting.  We have put together a quick guide that addresses some common questions and concerns on how to refer non-emergent psychiatric concerns to community outpatient resources and avoid unnecessary and costly ED visits

What kind of services are and are not available to children with psychiatric/behavioral complaints in the ED?

Psychiatric assessments in the medical ED setting are brief and focused.  They are not full psychiatric evaluations and are not meant to provide new diagnosis or start new medications.   They are simply a crisis assessment to evaluate for the child’s safety and the safety of others. If a patient is deemed unsafe to self or others, they will be transferred to a primary psychiatric facility for further treatment.  It is an assumption of many community providers that patients with psychiatric complaints must first be directed to a medical facility for “medical clearance”.  In fact, all psychiatric facilities are emergency receiving facilities and have the resources to provide medical clearance and directly accept healthy patients with behavioral and psychiatric complaints.  Most psychiatric hospitals perform psychiatric assessments 24/7,  and can place a patient on a 1013 or admit them voluntarily. Psychiatric facilities can also refer families to outpatient or lower levels of care if inpatient psychiatric hospitalization is not warranted. PLEASE NOTE CHOA DOES NOT HAVE INPATIENT PSYCHIATRY SERVICES.

What  intensive outpatient treatment options  are available for patients not in crisis?

Some psychiatric facilities offer Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP). A PHP is a nonresidential treatment program that is hospital-based. The program provides diagnostic and treatment services on a level of intensity similar to an inpatient program, but on less than a 24-hour basis.

An IOP Program offers group and individual services for 10-12 hours each week and allows individuals to participate in daily activities like school or work.

What outpatient resources are available in my area?

The Georgia Crisis Access Line (GCAL) is the first line referral for patients with medicaid or CMO’s looking for mental health services in Georgia.  GCAL can refer for emergency and routine psychiatric services and can be reached at 1-800-715-4225.   Patient or providers may search for community mental health providers in their area based on location and age group at http://georgiacollaborative.com/.  This is an online database of community mental health providers maintained by GCAL.  Providers can also ask parents, to look up mental health providers on their insurance provider’s website.

CHOA’s Behavioral Health Initiative Line (404-785-DOCS) is also available for community providers to ask general questions about psychiatric medications and management of symptoms on an outpatient basis.

What patients should I always send to the Medical ED first?    

Ingestions, psychiatric symptoms with coexisting medical symptoms ( i.e. fever, viral/bacterial illness, abnormal labs) and first break psychosis should  be directed to medical ED first.