PES Portal: a community engaged research project to help patients and families understand psychiatric emergency services and have an informed voice in care decision-making

PI: Carolina-Nicole Herrera, Doctoral Candidate, Department of Health Law, Policy, and Management, School of Public Health
Co-PI: Alison Duncan, MD, Assistant Professor, Department of Psychiatry, School of Medicine; Director of Psychiatric Emergency Services, Boston Medical Center

During the pandemic, children (0-17) were presenting in emergency departments with higher levels of acuity/severity, requiring more intensive psychiatric care. Psychiatric emergency services (PES) are designed to stabilize patients and prepare them for treatment following discharge. As part of that process, guardians and clinicians engage in shared decision making (SDM) when developing a discharge plan that could result in multiple life changes including, but not limited to, inpatient placement outside of Boston, medication therapy, or in-home interventions. In a prior study performed by members of this team, Boston-area youth of color and their guardians reported feeling frustrated by the paucity of information about PES and post-PES services and felt that they were not always given the information they needed to make an informed decision about their child’s care. Recent work suggests that mental health literacy interventions can improve SDM.

This study explores to what extent mental health literacy (MHL) materials can improve SDM during psychiatric emergency services visits. The research team hypothesized that (H1) MHL materials developed through community engaged research (CER) methods will be positively received by most families of color and clinicians; and (H2) guardian perceptions of SDM between clinicians and families will improve after the introduction of MHL materials (PES Portal).

The research team will test these hypotheses with community members drawn from pediatric patients who were treated by the Boston Emergency Services Team (BEST), their families, and their clinicians. Boston Medical Center runs BEST’s psychiatric urgent care centers, psychiatric emergency departments, mobile crisis team, bridge clinic, and triage hotline that serve the greater Boston region and New Bedford. More than 60% of pediatric encounters are with people of color. With guidance from a community advisory board, the research team will develop a multilingual PES Portal. CER has been used successfully to improve MHL and SDM in a variety of settings, but never in the psychiatric emergency department. Herrera and Duncan will evaluate the efficacy of the PES Portal through pre-implementation focus groups and pre/post implementation surveys. Findings will contribute to the literature on SDM, MHL, CER, health equity, and the delivery of PES. The research team anticipates that PES Portal will have been used in more than 4000 PES encounters by the end of 2023.

See more of our 2022 Early Stage Urban Research award recipients here!