Jessica Pierre Francois, MD completed her pediatric residency in the Massachusetts General for Children in Boston, MA. Throughout her time there, she was involved in leadership initiatives such as the Health Equity and Program Evaluation committees, which focus on antiracism, diversity, and inclusion efforts in the residency program. Dr. Pierre Francois has a well-developed passion and interest in community health; she understands the impact of community-wide initiatives in addressing health disparities. As an elected member of Gold Humanism Honor Society, Dr. Pierre Francois has been involved in initiatives like The Barbershop Health Network: “Doc n’ the Shop,” an initiative aimed at addressing health disparities in vulnerable populations in Worcester, MA through community-based outreach and health education at local barbershops and community centers. Dr. Pierre Francois aspires to be part of leadership that continues to foster the growth, innovation, and sustainability of community health center work throughout Massachusetts. She is an inaugural fellow in the Boston Children's Fenwick Institute Fellowship in Pediatric Health Equity and Policy through a collaboration with the Commonwealth Fund Fellowship. She is currently a Pediatrician at Codman Square Health Center in Dorchester, MA. Dr. Pierre Francois earned her medical degree from UMass Chan Medical School in 2020.
Jessica Pierre Francois, MD
Research Fellow, Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children’s Hospital, Boston, MA
Pediatrician, Codman Square Health Center, Dorchester, MA
Looking at the Landscape of Mental Health ED Revisits among Youth
Objectives:
- To understand the sociodemographic, clinical, and relevant outcome data of the pediatric population who utilize the emergency department (ED) for mental health care nationally
- To identify the community mental health needs of the pediatric population in Boston
- To evaluate existing policies aimed at reducing unnecessary pediatric mental health ED revisits
Background:
Mental health and behavioral health disorders in the United States of America have long been one of the leading causes of poor life outcome in the pediatric population over the past decade (2022 NHQDR Report). Prior to COVID-19, 1 out of 5 children experienced a mental health disorder and approximately 50% of all adults with behavioral problems reported that these issues began in their youth (MAHP 2023). The pediatric mental health crisis in the US was significantly exacerbated by the COVID-19 pandemic in 2020. The increase in mental health disorders such as anxiety and depression in the pediatric population has more than doubled since the COVID-19 (SAMHSA 2023). Per the National Survey of Children’s Health, in 2020, suicide was the leading cause of death for children and adolescents aged 10-14 per HHS Centers for Disease Control and Prevention.
The Emergency Department (ED) has become a primary access point and safety net for many pediatric patients given the shortages of behavioral and mental providers. From 2011 to 2020, the number of pediatric mental health and or behavioral health related visits increased by 8% (Bommersbach et al., 2023). Underserved populations are more likely to receive care for mental health or behavioral disorders in the ED (Howell et al., 2008). However, EDs are not adequately resourced or set up to manage mental and or behavioral disorders. Several studies assessing ED characteristics demonstrated that hospitals serving primarily low-income children were less likely to have pediatric-specific behavioral health policies and resources (Foster et al. 2024). These deficiencies contribute to longer boarding times and less effective care for children with mental health needs in these settings.
Methods:
Dataset: Pediatric Health Information System
Study Cohort: Patients aged 11-18 years old presenting to the ED for mental health concern
Study Design: Multi-institutional retrospective cohort study; Chi-squared test, p value < 0.05
Primary Outcome: Index visit defined as the first mental health related ED visit from 2019 through 2023, allowing for a one year follow up for mental health related ED visit through December 2024.
Exposure: Child Opportunity Index Level (COI)
Results:
There are significant sociodemographic differences, mental health diagnoses, and additional management in pediatric patients in pediatric patients who present to ED for mental health concern based on COI level. Community Health Needs Assessment help properly detect the specific needs of community and properly guide organizations to develop and direct resources to address those needs.
Future Directions:
- Present findings to BCH community needs assessment team and MassHealth;
- Continue to engage with community organizations to determine areas for additional support;
- Strength school based-mental health supports services
Preceptor:
Valerie Ward MD, MPH Senior Vice President, Pediatric Health Equity Strategies; and Chief Health Equity Officer, Boston Children's Hospital; Pediatric Radiologist, Department of Radiology
