Pediatric Attending
New York City Health and Hospitals
A Cross-Sectoral Solution to Youth Violence in East Harlem
FOCUS
Children in conflict often get hurt at the intersection of systems that are supposed to nourish and protect them. A school altercation is allowed to escalate. The police come bearing handcuffs. A child is brought for dearth of options to the hospital. The triage nurse registers a complaint of danger to self, resulting in transfer of the individual into a locked-down psychiatric facility, meant for adults. The end of the line facility in this scenario is Metropolitan Emergency Department in East Harlem but this might as well be anywhere. Caring adult professionals with community partners must commit to a cross-sectoral approach to problems that put children’s health and development first. For this particular problem we establish conflict resolution programs in Harlem schools, youth-centered protocols for how police deal with children and a separate pediatric psychiatric assessment area in Metropolitan’s Emergency Department.
STRATEGIC INITIATIVE: Create a Redirection System to Effectively Address Pediatric and Youth Psychiatric Health
Children in conflict often get hurt within and at the intersection of systems that are supposed to nourish them. An altercation between unsupervised youth escalates. An adult calls the police. A child is cuffed and then brought to the local hospital. The triage nurse registers a complaint of danger to others, resulting in transfer of the patient to a locked-down psychiatric assessment area that mixes children with adults. The end-of-the-line facility in this instance is Metropolitan Emergency Department (ED) in East Harlem, but this might as well be anywhere. EDs nationwide are being inundated, not only with psychiatric emergencies but with behavioral health referrals from schools and families, which once managed their own conflicts. From 2012 to present, youth visits to EDs for psychiatric or behavioral health reasons increased 25 percent. Blacks and Latinos are overrepresented, both in the 25 percent increase and 10 percent baseline prevalence of psychiatric and behavioral health diagnoses. For our initiative, we build intra- and inter- institutional solutions that put children’s total health first. This entails establishing mental health emergency triage tools and processes that quickly and safely route children to the most appropriate care, constructing a pediatric psychiatric assessment area separate from adults, running two group leadership programs of 25 youth who meet weekly—one school-based and the other in a public housing community center—and establishing an East Harlem consortium committed to collaborative long-term action on behalf of youth mental health.
MORE ABOUT WILSON
Dr. Wang’s first job out of University was as a middle school science teacher in urban Oakland. The lessons he learned in the classroom on social health determinants became the backdrop for a 12-year career in clinical pediatrics, health system design, and public health. Dr. Wang will do anything for the health of children starting with the obvious: Putting children first.
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