Innovation for Improved Care

In the fourth quarter of 2018, just 3 months, United Counseling Service completed 294 crisis evaluations on children with psychological distress who were patients in the Emergency Department at Southwestern Vermont Medical Center (SVMC). To maintain their safety, the children are asked to change into a gown. 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.

Staff at SVMC and United Counseling Service recognized that the Emergency Department is not the ideal place to care for patients with these symptoms. They created the UCS/SVMC Youth Psychiatric Urgent Care Model and applied for a $125,000 grant from OneCare Vermont to fund the project.

More than 30 applications were submitted, and just three projects we awarded funds to implement their ideas. The funds established and staffed a Youth Psychiatric Urgent Care Center, a home-like environment stocked with kid-friendly activities. The Center partnered with a single referring site, as a test, and has been accepting patients since September.

In the past, staff at the site 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. Now, instead, the site calls the Center. From there, the child can be treated by UCS’s specialists and, in the greatest number of circumstances, 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 the it to serve adults as well.