“Mental health issues have been on the rise among children, and that has been further exacerbated by the pandemic,” said Anjali Joseph, director of the Center for Health Facilities Design and Testing and professor of architecture. “There is a shortage of adequate mental health resources in the community, and this has resulted in an increasing number of kids with mental and behavioral health issues showing up in emergency rooms, which are really the worst place for them.”
Emergency rooms often are not equipped to deal with children with severe mental and behavioral conditions who may not have any visible physical problems. Faculty from Clemson and the University of South Carolina will partner with Prisma Health on a $2 million grant from the Agency for Healthcare Research and Quality to improve that situation.
The multidisciplinary team will be led by Joseph, along with Dr. Ann Dietrich, the pediatric emergency department chief for Prisma Health Upstate, and Dr. Meera Narasimhan, chair of the department of psychiatry at Prisma Health and special adviser to the University of South Carolina President for Health Innovations.
“Between 2010 and 2018,” said Dietrich, “mental health concerns and suicide rates rose consistently, and in 2018, suicide was the second-leading cause of death in children between 10 and 24 years of age.”
Researchers will analyze the ways current emergency department workflows help or hinder care for children’s mental and behavioral health needs, then design human-centered work systems to improve care. The final part of the process will be to integrate, implement and evaluate the new systems.
Joseph, whose research specializes in health facilities design, said that most emergency departments were not designed or staffed for the needs of patients — especially children — with severe mental and behavioral health conditions. The result is long wait times for patients in distress. She noted that BIPOC (Black, Indigenous and people of color) children are disproportionately impacted by shortcomings in mental and behavioral health care.
The team includes Clemson faculty from the College of Architecture, Arts and Humanities; the College of Engineering, Computing and Applied Sciences; and the College of Behavioral, Social and Health Sciences, as well as researchers from Prisma Health.
Emergency rooms aren’t alone in the struggle with children and mental health.
Researchers from Clemson and the University of South Carolina are using a $4.6 million award from the South Carolina Department of Education to help districts and schools across the state support students with social, emotional and behavioral needs.
They are developing the Behavior Alliance of South Carolina — a group of researchers, education professionals and district representatives — that will guide districts in collecting and analyzing data to define needs, provide professional development, and assist in implementing an evidence-based approach that supports all students.
Shanna Hirsch, associate professor of education at Clemson, and Mark Samudre, assistant professor of education at the University of South Carolina, will be project directors for the alliance.
“Our plan,” said Hirsch, “is to work with districts to help them create positive learning environments while improving social, emotional and behavioral outcomes for students.”
According to Samudre, the benefits for all teachers — not just special education teachers — are a main feature of the support systems that will be put in place. A former special education teacher, Samudre’s research focuses on equipping general education teachers with the same tools to implement intensive behavioral supports that special education teachers employ on a day-to-day basis.
“When teachers effectively manage student behavior, they increase their time for academic instruction, which helps all students,” Samudre said. “The benefits here are not limited to a single student or classroom or school. But, as one of my mentors often reminds me, meaningful changes in student behavior often depend on some initial change in teacher behavior.
“In sum, we hope our work through the alliance will support teachers so they can more effectively support students.”