TABLE 3.

Additional Areas for Future Study and Exploration in Pediatric Boarding

Issue	Contributing variables
Excessive boarding times	Need for specialty care units (e.g., autism/developmental disability, concurrent physical health needs, eating disorders, aggression) Insurance status Bed availability Risk of behavioral events and negative outcomes
Utilization of nonphysician, multidisciplinary team members (APPs, behavioral health RN, SW, ancillary therapeutic and educational staff)	Supervision Availability of child psychiatrists Lack of standardized programming
Creating therapeutic milieu	Parental visit supervision, length, and frequency Meal planning Access to outdoor activities
Timely access to intermediate levels of care	Limited access to: Short-term bridge clinical services Wraparound programs Partial hospitalization and intensive outpatient programs Other community-based programming (e.g., respite, urgent care, crisis clinics)
Reimbursement	No clarity or standards for billing for patients who are boarding
Data collection and analysis	Feasibility and variability of data collection IRB requirements and data sharing across institutions
Advocacy	Law enforcement and emergency medical services involvement with patient transportation Legal concerns among youth involved in criminal activity or other juvenile delinquency Insurance parity with behavioral health carve-outs