Charlotte Pilot Program Shows Success in Reducing ER ‘Boarding’ Crisis
Charlotte’s innovative CITE program has dramatically cut emergency room waiting times for children in mental health crisis, offering hope for statewide solutions.
RALEIGH, NORTH CAROLINA — State legislators are examining a Charlotte pilot program that has significantly reduced the time children in mental health crisis spend waiting in emergency departments without treatment, as officials seek solutions to address a statewide “boarding” crisis.
Leaders from the Carolina Complete Health Network in Charlotte presented results from their Crisis Intervention Therapy and Education (CITE) model to the state House Health Committee on Tuesday, showing promising outcomes in reducing prolonged emergency department stays for at-risk youth.
The CITE Model Components
Katie McKay, the senior director of clinical operations for CCHN, outlined the three-step approach that begins with stationing a dedicated behavioral health clinician in the emergency department. This clinician serves as the primary contact for families and identifies appropriate treatment options for children in crisis.
The second component involves referrals to MORES, which stands for Mobile Outreach, Response, Engagement and Stabilization. This mobile provider can respond within an hour of a crisis and provides up to eight weeks of follow-up care. The program receives public funding from the N.C. Department of Health and Human Services but is not yet available in every county.
The final step includes family education provided by the MORES team on recognizing crises, responding appropriately, and accessing resources beyond emergency room visits.
Dramatic Improvements at Presbyterian Medical Center
Dr. Michael Utecht, chief medical director for Carolina Complete Health, described severe cases before the pilot’s implementation at Novant Health Presbyterian Medical Center. Some children in crisis were being boarded for four to six weeks, occupying bed space without receiving behavioral health treatment or social interaction.
“One 13-year-old, he was there for seven months. He gained 100 pounds. These are horrific stories. But this is what happens because there’s not much else to offer,” Utecht said.
Since implementing the pilot program, the average length of stay for children in these “social holds” has been significantly reduced, though specific statistics were not provided in the presentation.
Statewide Mental Health Crisis
The boarding crisis affects children across North Carolina who are brought to emergency departments by families or law enforcement during mental health emergencies. While these children have no physical ailments requiring hospital admission, behavioral problems prevent their safe release.
Legislators have become increasingly familiar with these cases as emergency departments struggle to provide appropriate care for youth experiencing mental health crises. The Charlotte pilot offers a potential model for addressing similar situations statewide.
The success of the CITE model comes as mental health concerns continue to affect North Carolina’s youth population, with recent data showing one in four teens experiencing depression across the state.
