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Emergency Department Use for Mental Health Problems by Youth in Child Welfare Services.

Objectives
In Canada, little research has focused on emergency department (ED) use by youth involved with child welfare services, a vulnerable population. Our aims were therefore (1) to examine the characteristics of ED users among child welfare-involved youth, 2) to identify predictors of ED use and 3) to identify youth trajectories to EDs.


Methods
Data were collected from child welfare charts from two agencies in Montreal, Canada. Logistic regression was conducted to determine the predictors of ED use. Latent class analysis was used to identify trajectories to the ED.


Results
The sample included 226 youth aged 11-18 years. 33% of youth visited the ED at least once for mental health problems during child welfare involvement. ED users were more likely to be youth with a history of 1) sexual abuse, 2) parental mental illness, and 3) placements outside of the home, compared to youth with no ED visits. Mental health treatment was initiated in the 30 days following an ED presentation in 24% of cases. Three trajectories were found: 1) ED contact initiated by child welfare workers for suicidal ideation/attempts, 2) ED contact initiated by police for substance use and externalized behaviours and 3) ED contact initiated by parents for suicidal ideation/attempts.


Discussion
Despite all youth being followed by child welfare and many already receiving mental health services, youth had high, often recurrent ED use. This highlights the need for stronger coordination between child welfare, youth mental health services and EDs.