A Research Agenda for Acute Pediatric Mental and Behavioral Health Emergencies

Abstract

Study objective To identify high-priority research questions related to emergency care of children with mental and behavioral health conditions and develop a consensus-based research agenda. Methods We recruited expert partners to participate in a modified Delphi method to develop a consensus-based research agenda. The Pediatric Emergency Care Applied Research Network Mental Health Working Group formulated initial research priorities, informed by literature review. Expert partners modified, added to, and rated proposed research priorities on a 9-point scale across 3 survey rounds. Ratings assessed overall priority, followed by need and urgency, research impact, and family centeredness. Top tier priorities had a median of at least 7 for all 3 domains and a median over 7 in at least 2 domains. Results The 23 expert partners included 4 parents/caregivers and 1 young adult with lived experience, 9 physicians with various training backgrounds, 3 nurses, 3 social workers, 2 out-of-hospital clinicians, and 1 program officer. Of 76 initial research priorities, 41 were dropped and 16 were newly proposed; the expert panel reached consensus on 51 research priorities. Thirty-one top tier research priorities encompassed aspects of out-of-hospital care (eg, training, novel response models), general emergency care and boarding (eg, brief interventions), management of acute agitation (eg, effectiveness of de-escalation methods and medications), suicide prevention (eg, effectiveness of safety planning), and optimal postdischarge follow-up care. Conclusion This consensus-based research agenda, which integrates diverse perspectives, informs the need for research to improve identification and management of children at risk of harming themselves or others in the out-of-hospital and emergency department settings.