Peer Support Enhanced Behavioral Crisis Response Teams in the Emergency Department

What is the research about?

When patients experience behavioral crises because of exacerbation of mental illness, alcohol/drug use and behavior changes, some may experience symptoms of agitation. Agitation is when patients develop excessive psychological distress and physical activity that can lead to violence and danger for themselves and staff caring for them. Emergency department (ED) staff sometimes must use physical or chemical restraint to treat agitation, but restraints can lead to harm for patients. There is evidence that a structured, organized clinical response team can help minimize use of restraints on patients. Peers, or peer support workers, are people with lived experience of behavioral illness along with professional skills and training that can provide support to patients experiencing behavioral crisis.

This study is comparing the use of peer support services embedded within a structured clinical response team to patients experiencing behavioral crises in the ED to current standard of care.

Who can this research help?

Hospital administrators, state agencies and clinical staff can use findings from this study to determine if peer support workers can help patients with agitation symptoms and how best to incorporate peers in the ED setting.

What is the research team doing?

The research team is working with a large regional healthcare system in Southern New England across five EDs to enroll 57,870 visits for adults 18 years or older who either present with a behavioral problem or are at risk for agitation symptoms during their stay. Each ED will have a baseline period where standard of care occurs, and staff deliver usual ED care for managing behavioral crisis following best practice recommendations. Subsequently, each site will sequentially be assigned to receive the peer-supported structured clinical response team intervention.

Peer support workers will approach patients, conduct an initial assessment, build a therapeutic relationship, and offer behavioral-related resources. If a patient starts to experience distress, peers will continue to help allay patients’ distress. If at any point the patient becomes severely agitated, the structured crisis response team will proceed with management and peers will continue to work alongside the clinical staff as needed. The goal is to decrease the use of physical and chemical restraints during ED visits, improve patients’ experience/recovery, help connect patients to proper follow up and decrease their need to return to the ED.

The research team is working with patients with lived experiences of being restrained in the ED, healthcare clinicians, hospital administrators, peer specialists and representatives from community organizations to design and conduct this study.