In the fourth quarter of 2018, just 3 months, United Counseling Service completed 294 crisis evaluations on children with psychological distress who were in the Emergency Department at Southwestern Vermont Medical Center (SVMC). To maintain their safety, the children are asked to change into a gown and their personal belongings are removed. The experience can further traumatize those who are already having emotional and behavioral difficulty. After all of that, 82 percent were released to their homes without behavioral health treatment or treatment plan.
Staff at SVMC and United Counseling Service recognized that the Emergency Department is not the ideal place to care for patients experiencing psychological distress. They worked together to create the UCS/SVMC Youth Psychiatric Urgent Care Model and applied for a $125,000 innovation grant from OneCare Vermont to fund the project.
More than 30 applications were submitted, and just three projects were awarded funds to implement their ideas. The funds established and helped staff the Psychiatric Urgent Care for Kids program or PUCK, a home-like environment stocked with kid-friendly activities and sensory tools. PUCK originally partnered with a single referring site, a local elementary school, as a pilot, and has been accepting referrals for services since September.
In the past, staff at the school would have called the police or 9-1-1 for a child experiencing a psychiatric event. The child would have been brought to the Emergency Department in the police car. Now, instead, the schools call PUCK. From there, the child can be treated by UCS’s specialists and, in all circumstances thus far, make a plan to return home.
“The new way of handling these cases is better for children and families, because the treatment matches their needs more closely,” said Jill Maynard, RN, BSN, CEN, SANE, director of Emergency Nursing at SVMC and one of the authors of the project. “In addition, it improves care for all by making better use of the Emergency Department, freeing it up for patients who need the type of care it is equipped to provide.”
“Children who are seen in Emergency Departments for a mental health concern are often traumatized by the very intervention we provide, said Lorna Mattern, Executive Director of United Counseling Service. “We are now able to provide the right care in a therapeutic environment that improves outcomes for children and reduces cost.”
If found to be feasible, the program will become permanent and expand to additional referral sites. One day, the originators of the program would like to replicate it to serve adults as well.