Management of agitation symptoms during mental health crises is a prevalent challenge in the emergency setting, yet resources and evidence-based treatment are particularly lacking. Unfortunately, marginalized and minority populations with behavioral disorders are disproportionately affected.
A research team led by Ambrose Wong, MD, MSEd, MHS, and Rebekah Heckmann, MD, MPH, MPA, from the Department of Emergency Medicine at Yale School of Medicine, has been approved for a $3.7 million R01 award by the National Institute of Mental Health to address this problem. Their project, System Dynamics Modeling to Promote Health Equity in Management of Agitation, will evaluate drivers of disparities in agitation care and workplace violence and identify patient-centered interventions that will also ensure staff safety using participatory group model-building techniques with patients, security officers, and clinicians. Specifically recruiting individuals from disadvantaged and minority populations, they aim to ensure an emphasis on health disparities throughout the research process.
Our approach addresses patient advocacy and staff safety as related issues within one unifying systems model and recognizes that both issues need to be addressed for any potential interventions to be effective.
Rebekah Heckmann, MD, MPH, MPA
Dr. Heckmann, an emergency and addiction medicine physician and Research Scientist at the Yale Center for Outcomes Research and Evaluation, has extensive experience performing health policy analysis and has had led CDC-funded efforts on behalf of the Connecticut Department of Public Health to evaluate the impact of Good Samaritan Laws using SD methods. “Our approach addresses patient advocacy and staff safety as related issues within one unifying systems model and recognizes that both issues need to be addressed for any potential interventions to be effective”, says Heckmann.
A pioneer in the field of acute agitation research, Dr. Wong has collaborated with informatics and human factors experts on a series of landmark publications that described physical restraint use in the emergency setting and identified disparities in behavioral care. According to Dr. Wong, “The project is a collaborative effort combining Dr. Heckmann’s expertise in system dynamics modeling with our team’s focus on patient-centeredness for managing symptoms of patient agitation that can lead to aggressive and violent behavior. We hope that this process can also alleviate some of the disparities that we have seen in how agitation is managed, especially around use of sedation and physical restraints.”
Other researchers on the grant include Yale’s Bidisha Nath, MBBS, MPH; Joseph Ross, MD, MHS; Karen Wang, MD, MHS; Chyrell Bellamy, MSW, PhD, along with Nasim Sabounchi, PhD, MS, from CUNY and Jessica Ray, PhD, MS, from the University of Florida.
The Department of Emergency Medicine at Yale is ranked first in the nation in research dollars awarded by the National Institutes of Health—a demonstration of their commitment to their mission to advance the science and practice of emergency medicine care as we continue to push the envelope of science and advocate for our patients and communities. To learn more, visit https://medicine.yale.edu/emergencymed/