Objectives Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting.1 Since the pandemic, there is evidence that both numbers of paediatric admissions and the severity of MH crisis in CYP have increased, and paediatric teams are experiencing challenges delivering safe care.2 There is a general paucity of published data on CYP with MH crisis admissions to general paediatric wards including total numbers, factors associated with admissions, outcomes for CYP admitted, and the impact of admissions on CYP, parents and healthcare professionals (HCPs).
We aim to generate a Theory of Change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting in a MH crisis. Our objectives are to investigate: 1) national trends in admissions; 2) characteristics of admissions (sociodemographic factors, diagnoses and reasons admitted) 3) factors influencing decisions to admit CYP; 4) views/experiences of CYP, families and HCPs during admissions.
Methods We will conduct a mixed-methods study to inform a ToC framework, alongside a stakeholder group (consisting of patients, families, health and social care professionals and professional groupings). To achieve this, we will: 1) analyse national service level data (hospital episode statistics) of MH admissions to paediatric wards, 2) undertake a rapid literature review and bring together the research team and stakeholder group, using a modified Delphi process, to develop a data collection instrument on MH admissions at paediatric wards, 3) implement a prospective reporting system of MH crisis admissions from 15 paediatric wards in England and 4) carry out a qualitative study of the experiences of CYP admitted in MH crisis at 5 paediatric wards, as well as their families and staff members caring for them. Findings will be discussed with the stakeholder group so a final ToC can be developed with outputs agreed to achieve impact.
Results Analysis of the national data and screening of the data for the rapid literature review are in progress. Results will be available at the conference.
Conclusions Primary outcomes of this study will be the characterisation of admissions for primary MH problems to acute children’s wards, the co-creation of a data collection instrument, and the characterisation of the views/experiences of CYP, families and HCPs. Moreover, by producing a ToC approach, we expect to generate a system map to identify recommendations and transformation plans to share with policymakers, commissioners, service leads, and professionals.
Royal College of Paediatrics and Child Health. A snapshot of general paediatric services and workforce in the UK. Report, 2020.
Hudson LD, Chapman S, Street KN, et al. Increased admissions to paediatric wards with a primary mental health diagnosis: results of a survey of a network of eating disorder paediatricians in England. Arch Dis Child. 2021.
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