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Providing Comprehensive Psychiatric Emergency Care for Children and Teens

New York (Mar 29, 2010)

mother comforting teen daughter

Every year, thousands of children and teens in Manhattan are brought to emergency medical services for psychiatric crises. Some are evaluated and held in busy non-psychiatric pediatric emergency departments, or brought to adult psychiatric emergency settings, which can be frightening to these young, vulnerable patients. What they really need, however, is a safe, non-threatening environment staffed with child psychiatric specialists who can quickly help them calm down, evaluate them, and refer them to the appropriate treatment. The Child and Adolescent Comprehensive Psychiatric Emergency Program (C-CPEP) in the Emergency Department at NewYork-Presbyterian Morgan Stanley Children's Hospital does just that.

Children and adolescents can experience psychiatric crises. These may stem from or cause serious problems at home and at school as well as place enormous stress on family members. Mental health problems in this age group are more common than many people may realize. In fact, according to the United States Department of Health and Human Service's Substance Abuse and Mental Health Administration, studies show that at least one in five children and adolescents has a mental health disorder and at least one in 10 has a serious emotional disturbance. Left untreated, these disorders possibly can lead to school failure, isolation from peers, drug abuse, violence, and even suicide.

Opening in Fall 2004, C-CPEP was the first comprehensive program of its kind in New York State dedicated to responding to child and adolescent psychiatric emergencies. Staffed around the clock, seven days a week with child and adolescent psychiatrists, nurses, case managers, and psychologists, the program oversees between 1,200 and 1,500 patient visits each year. One-third of those patients are under 12 years of age; the majority are between 12 and 19. Patients are usually referred to the Emergency Department by their physicians, schools, or sometimes through a 911 call.

As soon as the child or adolescent arrives at the Morgan Stanley Children's Hospital Emergency Department, he or she is evaluated by a pediatric medical team. If the young patient is medically cleared (i.e., the problem is not caused by an acute medical issue), the next step is a referral to C-CPEP for a comprehensive psychiatric evaluation; if the child is not "cleared," the psychiatric team will be involved as consultants to the pediatric medical team.

"Each patient referred to C-CPEP is immediately evaluated and if that patient is under the age of 18, his or her parent or legal custodian must be present during that process," says Pablo Goldberg, MD, Clinical Director of C-CPEP, Division of Child and Adolescent Psychiatry at Morgan Stanley Children's Hospital. "Unlike other emergency departments, patients can be held up to 72 hours in an extended observation three-bed unit when necessary in order to stabilize acute psychiatric symptoms."

More than 90 percent of patients who visit C-CPEP are treated and released as outpatients for continuing care and monitoring. "Our goal is to avoid unnecessarily hospitalizing these children and adolescents in psychiatric facilities that may be far from their families and instead to provide them with the most appropriate treatment" says Dr. Goldberg.

Patients are often referred to one of two C-CPEP programs. The Home-Based Crisis Intervention program helps stabilize patients on an outpatient basis. A psychologist, social worker, and two case managers, who are available 24 hours/seven days a week, conduct home and school visits and stay involved with each patient and their family for up to eight weeks.

The Intermediate Treatment Clinic (ITC) is specifically available to those young patients who do not need to be admitted to the Hospital but who still require regular follow-up. During the six or eight weeks patients are seen in the ITC, staff determine which long-term outpatient program is most appropriate for the patient's treatment and for their family.

Both programs allow patients to remain at home, and provide their families with the support needed during an often difficult and challenging time.

For more information on C-CPEP, call (212) 305-0854.

Faculty Contributing to this Article:
Pablo Goldberg, MD, Clinical Director of C-CPEP, Division of Child and Adolescent Psychiatry, NewYork-Presbyterian Morgan Stanley Children's Hospital, and Assistant Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons.

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