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Pediatric Behavioral Health Urgent Care: An Innovative Model of Care for Children and Adolescents

The Cohen Children’s Pediatric Behavioral Health Urgent Care Center (“BH Urgi”), located on Long Island, NY, is an alternative treatment setting for school-aged children and adolescents ages 5 through 17 in need of urgent mental health support. BH Urgi is intended to provide urgent or same-day intervention for children and teens who need urgent psychiatric care and treatment but may not necessarily need to be seen in a hospital emergency room. There is also a community-embedded version of this model called the Behavioral Health Center (“the Center”), which expands on what BH Urgi can provide, provides collaboration with local school districts, and provides additional services to students and school staff alike. BH Urgi and the Center represent a unique model of care for children and adolescents that enhances access to care and quality of care and should be replicated in other communities.

Female psychologist with young girl during play therapy

The following are excerpts of a conversation with Vera Feuer, MD, Associate Vice President, School Mental Health and Director, Pediatric Emergency Psychiatry and Behavioral Health Urgent Care at Northwell.

How was the idea for the center first conceived and how long has it been in operation?

Cohen Children’s Medical Center, located in New Hyde Park, NY, and a part of the Northwell Health system, has operated its Behavioral Health Urgent Care unit since 2017. The unit was established through state funding with the goal of avoiding unnecessary emergency room visits and hospitalizations for children and adolescents experiencing mental health crises. However, this program was limited in the amount of care coordination and bridging services it was permitted to provide.

In 2019, following two student suicides, a local school district reached out to Northwell administrators to see if something similar to the BH Urgi program could be established in Southern Nassau County. In 2020, a free-standing, outpatient behavioral health center was opened in Rockville Centre, staffed by a child psychiatrist, a mental health counselor, and a medical assistant. This past July, a second location was opened in Mineola, New York. The Mineola location is staffed with child and adolescent psychiatrists, behavioral health counselors, care coordinators, administrative assistants, and front desk staff who are bilingual in English and Spanish. Both locations offer flexible schedules to accommodate patients in crisis who may need to be seen urgently.

Why is behavioral health urgent care such a valuable resource for children and adolescents in need?

The treatment needs of children and adolescents requiring psychiatric care and treatment can vary widely. Often, youth experiencing a mental health crisis end up visiting the emergency room at their local hospital because no other appropriate options are readily available, and resources can be difficult to access. This can result in additional burdens on the health care system as well as long wait times and extra stress for the patient and family. The Center is designed to address this very issue and ensure connection to the next level of care. Traditionally, there have been few standards governing emergency behavioral health care for children and adolescents. In the past, there were challenges establishing a link between emergency room visits and follow-up outpatient care and treatment. Professionals also began to recognize that children and families needed a different environment – one that was familiar, pleasant and accessible, reminiscent of a pediatrician’s office.

NYSPA Summer 2020

What unique services does The Center provide?

The central role of the Center is assessment, including a focused mental health evaluation and determining any immediate safety concerns or other needs. Following initial assessment and evaluation, the goal of the program is to link patients with community-based mental health treatment in their area, including psychotherapy, psychiatry and case management services.

Patients and families may be referred to Northwell clinics, non-Northwell clinics, private clinicians, subspecialty clinics, or group practices. The plan is for patients to be connected with care in the community as quickly as possible, so they are not lingering or left without resources. Past data has shown that the best results occur when a follow-up visit takes place within one week following a crisis visit. If more than one week passes, the follow up rates are extremely low because you lose momentum. The Center works to link patients and families with care in the community as quickly as practicable to ensure follow up and continued care. In the interim, the Center’s team will provide in-person bridging care or telephone follow-up until communication is established with a provider in the community.

The Center also coordinates care and collaborates with the referring school, pediatrician, outpatient provider or case manager and communicates findings and recommendations where appropriate. The goal is to break down silos and improve communication between schools, community providers and our team and to support and educate families. The key is guiding parents and children to recognize problems as they occur and providing assistance and intervention before it escalates to a crisis.

How do school districts partner with The Center?

Local school districts are able to use their state funding and select the Center from a list of services available through Nassau BOCES. Partner school districts receive exclusive, emergency access to the Center for their enrolled students as well as bridging care, case management services, consultative support, professional development activities and community education for students and families.

How are children referred to The Center?

The Center is available for referrals from partnering school districts, community providers and children and families. School districts are an important referral source for the Center as children spend a significant amount of time in school, making teachers and school personnel an excellent resource for referring children that may need evaluation and treatment. Families in need may also call the Center directly to obtain services if they feel their child needs to see a child psychiatrist or needs a connection to care.

What other programs does The Center offer?

The Center provides community education, including a webinar series for families, a newsletter and professional development programs for school staff. Upcoming webinar topics include Bouncing Forward: Resilient Parenting, Addressing Stress and Trauma in Families, Substance Use in Children and Adolescents, ERASE the STIGMA-A Family Event, and Mental Health in LGBTQ Youth.

Rachel Fernbach is the Deputy Director and Assistant General Counsel for the New York State Psychiatric Association.

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