One in 6 children in the United States has a mental or behavioral health condition, and nearly half never receive care from a mental health professional [1]. When a crisis hits, families often have only one place to go: the emergency department. Yet for many of the decisions made during those visits, from calming an agitated child to planning safe follow-up after a suicide attempt, solid research on what works best for children does not yet exist. A new PECARN project set out to change that by naming the research questions that matter most.
The paper, A Research Agenda for Acute Pediatric Mental and Behavioral Health Emergencies, published in Annals of Emergency Medicine, lays out 51 research priorities chosen by a panel that included parents, a young adult with lived experience, doctors, nurses, social workers, and emergency medical services clinicians [2].
Study Design
Hoffmann et al, on behalf of the PECARN Mental Health Working Group, used a structured group process called a modified Delphi. Starting from 76 candidate questions drawn from the medical literature, 23 expert partners revised, added to, and rated the questions across 3 survey rounds. The panel was built so that family voices counted equally: a question could only make the final agenda if both the family representatives and the clinicians and research funders rated it highly. Each question was judged on need and urgency, potential research impact, and how well it reflected what matters to children and families.
Results
The panel reached consensus on 51 research priorities, with 31 rated top tier. The top-tier questions cluster into 5 areas:
- Care before the hospital — how to train first responders in de-escalation, and whether teams that include mental health experts can help children in crisis, sometimes without an ER trip at all
- ER care and boarding — whether brief therapy during long ER stays helps children feel better and go home sooner, and whether home-based care can be a safe alternative to hospitalization
- Calming agitation safely — which calming approaches and medications work best for children of different ages and backgrounds, including children with autism, while reducing the use of physical restraint
- Preventing suicide — which screening tools best identify children at risk, and whether safety planning before discharge prevents future attempts; these questions made up 42% of the entire top tier
- Care after discharge — what actually helps families connect with mental health care after leaving the ER, a period known to carry high risk
Why This Matters
Children’s mental health emergencies have risen sharply over the past decade, and in 2021 the nation’s leading pediatric organizations declared a national emergency in child and adolescent mental health. Research funding is limited, so where it goes matters. This agenda gives PECARN, other research networks, and funders a shared map of the most urgent unanswered questions, shaped as much by families who have lived through these visits as by the clinicians who staff them.
Take Home Message
A national panel of parents, youth, clinicians, and researchers identified the 51 most important unanswered research questions about emergency care for children in a mental or behavioral health crisis. Suicide prevention topped the list, alongside safer ways to calm agitated children, better care during long ER stays, and stronger connections to follow-up care. The agenda will guide the next 5 to 10 years of PECARN mental health research.
Why is this important for patients and caregivers
- If your child ever needs emergency care for a mental health crisis, know that researchers are working to make that care safer, calmer, and more helpful
- Parents and young people with real experience of these emergencies helped choose what gets studied next, and their priorities counted as much as the doctors’ priorities
- Before leaving the ER after a mental health visit, ask the care team about a safety plan, follow-up appointments, and safe storage of medications and firearms at home
This blog post is a plain-language summary of the following journal publication:
Hoffmann JA, Foster AA, Krass P, et al. A research agenda for acute pediatric mental and behavioral health emergencies. Ann Emerg Med. Published online July 10, 2026. PMID: 42429726. doi:10.1016/j.annemergmed.2026.05.015
Interested in other PECARN research?
More PECARN research on children’s mental health:
- Identifying Acute Suicide Risk in Teens — King et al, Psychol Med, 2024. A PECARN study found that certain warning signs, such as trouble sleeping and feeling like a burden to others, often spiked in the 24 hours before an adolescent suicide attempt. PMID: 37947215. doi:10.1017/S0033291723003112
- Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth (CASSY) — King et al, JAMA Psychiatry, 2021. A PECARN team built and validated a brief, adaptive questionnaire that reliably identifies youth at risk for a suicide attempt during an ER visit. PMID: 33533908. doi:10.1001/jamapsychiatry.2020.4576
References
- Bitsko RH, Claussen AH, Lichstein J, et al. Mental health surveillance among children – United States, 2013-2019. MMWR Suppl. 2022;71(2):1-42. PMID: 35202359. doi:10.15585/mmwr.su7102a1
- Hoffmann JA, Foster AA, Krass P, et al. A research agenda for acute pediatric mental and behavioral health emergencies. Ann Emerg Med. Published online July 10, 2026. PMID: 42429726. doi:10.1016/j.annemergmed.2026.05.015
