Date of Conferral

2022

Degree

Ph.D.

School

Public Policy and Administration

Advisor

Gema G. Hernandez

Abstract

A significant portion of individuals with a behavioral health (BH) condition return to emergency departments (ED) seeking care, resulting in reduced quality of care, and contributing to disproportionate healthcare costs. Care can be improved and return visits to the ED reduced where behavioral health care and follow-up care planning are provided as part of their treatment. However, policies expected to create declines in ED use for behavioral conditions are typically in short duration or are difficult to use given other funding and policy constraints. With little known about how policy is supporting the engagement of ED staff who are critical in providing this care, this qualitative case study provides an understanding of how policy is supportive of behavioral health care to reduce return ED visits. Through the theoretical lenses of the theory of reasoned action (TRA) and the theory of planned behavior (TPB), this study has identified where ED staff feel supported by processes and the related policies and are therefore more likely to engage in those activities. Through interviews with eight individuals who have provided for behavioral health care in an ED, processes were identified that supported provision of care. Using a thematic analysis and pattern coding to develop major themes based on participant attitudes and beliefs, corresponding policies were then identified through online document searches. This study has shown how policies support ED staff in the provision of behavioral health care so that policymakers may enhance and strengthen effective approaches for ED staff to improve care for individuals who enter an ED with a behavioral health need while also reducing healthcare costs for hospitals, and government and private health insurance payers.

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