Policy Statement Supporting Access to Intermediate Levels of Care as a Strategy to Mitigate Pediatric Behavioral Health-Related Emergency Department Boarding
Background
Emergency departments across the country continue to board children in psychiatric crises for extended periods due to a shortage of inpatient psychiatric beds, staffing challenges, and other post-COVID-19 pandemic-related operational constraints. As a result, families continue to encounter long waits for services. These delays occur in a system where between 2019 and 2021, approximately 50–70 percent of children and adolescents with severe mental health impairment did not receive any outpatient mental health care, despite national recognition of a pediatric mental health emergency in 2021. Moreover, social, financial and geographic disparities in access to care continue to widen while system-level strain further exacerbates access failures.
Intermediate levels of care, such as Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP), provide a higher intensity of treatment than routine outpatient care but are less restrictive than inpatient hospitalization. They offer intensive stabilization, skills-building, crisis mitigation, and family involvement within the least restrictive setting and can prevent unnecessary inpatient hospitalization when youth can be safely maintained in their communities. Telehealth and hybrid intermediate levels of care models have also emerged as safe, effective, and often superior alternatives for many families, particularly those in underserved or geographically isolated regions. As such, intermediate levels of care serve as hospital and emergency room diversion options thereby reducing emergency room and pediatric hospital boarding.
To prevent unnecessary child psychiatric hospitalizations and provide an efficient, developmentally appropriate, family-centered approach to stabilize high risk youth, the American Academy of Child and Adolescent Psychiatry recommends:
- State and federal investments in intermediate level of care program infrastructure in every community, including rural communities and
- State and federal regulatory reforms that remove licensure, supervision, duration criteria, and prescribing barriers that currently impede access to telehealth and hybrid models of intermediate levels of care.
- Use of validated service intensity instruments in emergency departments and other crisis care settings to facilitate appropriate referrals to intermediate levels of care.