P3.181: Psychiatric Care Access Amongst Youth in Foster Care Presenting to the Emergency Department for Mental Health Crises

Background: Pediatric mental health disorders are on the rise, and often, these patients first present to the emergency department (ED) with a psychiatric crisis. Youth in foster care disproportionately have higher rates of mental health disorders than the general pediatric population and are more likely to need psychiatric care. This study aims to analyze the characteristics of youth in care with mental health concerns who presented to the Loyola University Medical Center ED between January 2021 and June 2024.

Methods: A retrospective chart review was conducted, with the criteria for review being ICD-9 diagnostic codes and a departmental database. Each patient (youth in care or otherwise) after presenting to the LUMC ED with mental health concerns was seen by Consultation Liaison Psychiatry, who deemed inpatient psychiatric care appropriate for the patient.

Results: Between January 2021 and June 2024, there were 69 patient encounters who were youth in foster care presenting to the ED that needed inpatient psychiatric treatment (gender M= 44 F=25, average age = 15.5 years, race: 58% African American, 27.5% White, 14.5% other). 49% of patients had a psychiatrist. As a subset of the analysis between January 2022 and June 2024, the general pediatric population had an average length of stay of 1.95 days (N=443, mean age= 14.05 years) compared to youth in care during the same time period was 2.68 days (N=47).

There were 14 encounters with 9 unique patients where care was only received in the ED with no transfer to an inpatient psychiatric facility (gender: M=4 F=5, average length of stay = 4 days, aggression as a complaint: N=8). 6 were declined inpatient psychiatric care due to the facility having no acute beds to manage aggressive patients. After receiving care in the ER, 2 patients were discharged to a new foster home and 2 patients who came to the ER were in their group home only for a few weeks upon arrival.

Conclusion: Further investigation is needed to better understand the reasons for youth in care having an increased length of ED stay compared to general pediatric patients. The limited availability of inpatient psychiatric centers to acutely manage aggressive patients likely negatively impacts children in foster care as the ED is less equipped to properly manage these patients.

Four out of the nine youth in care patients who were not transferred to inpatient psychiatric care despite this being a necessity were either recently placed in their foster home or were discharged to a new home. For these patients, the inpatient psychiatric facility may have declined them due to foreseeable post discharge challenges. The lack of access to psychiatrists for patients in foster care is likely a contributing factor to their mental health crisis that resulted in ED presentation.