The growing demand for pediatric mental health services has outpaced available psychiatric resources, resulting in a marked increase in “boarding” of children and adolescents in emergency departments (EDs). This clinical review article, co-authored by Petronella Bell, M.D., examines current challenges and introduces new guidelines designed to initiate treatment in nonpsychiatric hospital settings. The guidelines recommend structural and procedural changes such as separating pediatric patients from adults in ED environments, redefining the ED physician as the primary provider of care, and positioning child and adolescent psychiatrists in a consulting capacity either in person or via telepsychiatry.

Beyond structural adjustments, the review explores innovative models of care delivery. These include the establishment of EMPATH units (Emergency Medicine Psychiatric Assessment, Treatment, and Healing units), the integration of trauma-informed practices tailored for neurodiverse youth, and the use of I-CARE, a digital platform offering seven psychosocial skills training modules, to convert prolonged boarding into active treatment opportunities. Such approaches aim to decrease wait times, mitigate risks associated with extended boarding, and improve patient outcomes.

The authors underscore the critical need for interdisciplinary collaboration, enhanced care coordination, and the reduction of disparities in access and quality of pediatric mental health care. Telepsychiatry is highlighted as a particularly promising tool, enabling broader reach of psychiatric expertise, reducing strain on emergency services, and reframing ED boarding time as an opportunity for early therapeutic intervention.