Throughout the United States, youth wait for days, and sometimes weeks, in Emergency Departments (ED) for transfer to residential and inpatient psychiatric units. At the Duke University Hospital ED, an estimated 30% of total ED bed-hours (includes adults and children) are occupied by youth with mental health disorders. Since 2015 the volume of youth with mental health disorders treated in the Duke ED has increased by 10%, as has the volume of those with length of stay >24 hours. Patients who stay the longest – in some cases 2-4 weeks in the ED – are awaiting transfer to residential and inpatient psychiatric units.

Evidence suggests that earlier intervention in the outpatient setting may prevent utilization of ED, residential and inpatient psychiatric treatment. However, an estimated 60% of youth in the US with a mental health disorder goes without care. We will use Medicaid claims data to develop a predictive model for youth at increased 12-month risk for treatment in a residential or inpatient psychiatric setting. Through Duke’s affiliation with Northern Piedmont Community Care (NPCC), we have a relationship with Alliance Behavioral Health, our local behavioral health Medicaid managed care entity. Alliance Behavioral Health and Duke have a common interest in improving the health of youth with severe mental health disorders while reducing the need for resource-intensive levels of care, such as emergency, residential and inpatient treatment. This predictive model will support targeted interventions such as case management and intensive outpatient services through Duke’s Population Health Rounding™ model of care,  thus reducing the need for treatment in more resource-intensive settings such as the ED.