Computerized Assessment and Referral System Screener for Mental Health Evaluations in the Emergency Setting (CARS-SA)

Computerized Assessment and Referral System Screener for Mental Health Evaluations in the Emergency Setting

The Utility of the Computerized Assessment and Referral System (CARS) Screener for Mental Health Evaluations in the Emergency Setting

This is a hybrid effectiveness-implementation randomized controlled trial which will be conducted at the emergency department (ED) at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, Arkansas. The hypothesis of this study is that use of the CARS (a computerized mental health screener) will modify emergency department treatment of patients with previously undiagnosed mental illness.

This pragmatic mixed methods clinical trial will compare the intervention of providing a CARS screener report to emergency providers to not providing the report. It will also collect qualitative data regarding implementation of the CARS screener and report. Consecutive patients presenting when a research associate is available will be approached to participate. Patients will be approached after evaluation by an emergency physician. The Computerized Assessment and Referral System (CARS) is based on the Composite International Diagnostic Interview (CIDI), a validated instrument for assessing mental health diagnoses.CARS was piloted at 6 different sites in 2016, all in DUI populations. As CARS has not been specifically validated on non-DUI populations, investigators will collect alcohol history (see below). The CARS self-assessment version (CARS-SA) will be utilized in this study.

Emergency care providers for subjects in this group will receive a copy of the subject's CARS-SA summary results.

Emergency care providers for subjects in this group will not receive a copy of the subject's CARS-SA summary results.

Number of Participants With CARS Mental Health Diagnoses Made in the ED; the Number of Psychiatry Evaluations in the Emergency Department (ED); and the Number of Mental Health Referrals Made From the ED

The composite measure includes: the number of CARS mental health diagnoses made in the ED; the number of psychiatry evaluations in the emergency department (ED); and the number of mental health referrals made from the ED.

Inclusion Criteria: >18 years of age Not incarcerated English-speaking and English-writing (as translators will not be available for this study) Exclusion Criteria: Unable or unwilling to complete CARS screener Unable or unwilling to provide any history of alcohol abuse Currently presenting with a chief complaint of a psychiatric symptom Currently presenting with a substance use complaint History of a known psychiatric condition Patients taking psychiatric medication