The silent surge: How an innovative program at Cleveland Clinic is reaching kids in mental health emergencies — before it’s too late

Emergency departments across the U.S. have seen a sharp rise in pediatric mental health visits over the past five years — more than 45% nationally, and nearly 300% at Cleveland Clinic’s pediatric emergency rooms for patients under 21. These young people in crisis often experience longer emergency department stays, sometimes extending beyond 12 hours, especially when safe discharge plans are needed. 

“Embedding mental health providers into EDs is becoming more common — but more is needed. In my opinion, this should automatically be part of every emergency department across the nation,” said Joseph Austerman, DO, a child and adolescent psychiatrist at Cleveland Clinic main campus. 

Given the shortage of specialists available to care for all these patients, hospitals must step in with creative solutions to offer temporary support, explained Dr. Purva Grover, a pediatric emergency medicine physician at Cleveland Clinic’s Fairview Hospital. In response to this critical gap, she and her team launched a new approach in the pediatric emergency departments: peer-to-peer and educational mental health videos shown to young patients in crisis as they wait for further care.

Funded by a Cleveland Clinic Catalyst Grant, these peer-to-peer videos feature unscripted testimonials from young people of diverse ages and gender identities. They are offered to eligible patients to watch on iPads while waiting to see a clinician. The peers share their personal mental health journeys, including what to expect during an emergency department visit or inpatient admission. 

The videos are designed to provide comfort and clarity during what can be a stressful waiting period, Dr. Grover shared. “It’s the power of the story — peer videos are the most watched, over and over, because they ease fear, reduce anxiety, and help patients feel less alone in the unknown,” she said.

The storytellers — patients within the Cleveland Clinic Health System — once sought care in the ED themselves. They have been thoughtfully selected to ensure that their volunteer participation supports their well-being, as they are further along in recovery and fully understand how their stories will be used as part of the intervention.

“Many volunteers say that sharing their stories helps them feel a sense of ownership over their health journey and allows them to give back by supporting other kids going through similar struggles,” said Dr. Austerman.

In addition to the peer-to-peer videos, the iPads showcase Cleveland Clinic psychiatrists or psychologists, teaching basic techniques from cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). These include skills to manage stress, regulate emotions, and promote mindfulness for both patients and their families. 

“What really matters is hope — making kids and their families feel they’re not alone, that others have walked this dark path, and things can get better,” said Dr. Grover. 

Impact in Action: Pilot Program in Progress

While the full impact is still being measured, early signs suggest promise. Existing research shows that peer support for people in crisis can reduce re-hospitalization rates, increase engagement with services, and promote recovery. This program builds on evidence-based peer support and skills-based interventions in positively improving mental health outcomes. These types of low-intensity, scalable tools have been shown in other care settings to improve quality of life and increase engagement with care.

Incorporating technology allows clinicians to meet patients where they are, in a way that is both efficient and timely. “Part of the reason for the video is being able to do this without expending a lot of staff time — which can instead be used to assess patients, make treatment plans, and support the whole care team,” added Dr. Austerman. 

However, not all of the interventions have been tested on pediatric patients. Dr. Grover and her team are closely monitoring patient feedback and engagement metrics during the pilot, and are currently planning to write a manuscript about this program in the coming months.

“Over and over again, it’s the peer-to-peer videos that families tell us are the most popular,” shared Dr. Grover.

Limitations and Challenges: Opportunities for Growth

While this intervention offers meaningful support, it is only a temporary measure — not a solution to the broader systemic problems. “This doesn’t replace or supplement true mental health care — these videos are ancillary tools to support patients through difficult moments, but in the big picture, they’re still a band-aid,” shared Dr. Grover. 

Other challenges include ensuring videos are developmentally appropriate, culturally sensitive, and resonate with the diverse experiences of youth. However, doctors Austerman and Grover have a plan to address this. “We’re working on using AI technology to make the videos more interactive, allowing kids and families to get answers to specific questions and become active participants in the decision-making process,” said Dr. Austerman. 

Additionally, having multiple staff members available may not be feasible in all settings—particularly in smaller or under-resourced hospitals.

“You can’t be physically present in the ER 24/7, so when you create a new process like this, you need staff buy-in. Having champions—like crisis workers or empathetic nurses—makes all the difference in getting patients access and actually operationalizing the program,” explained Dr. Grover. 

However, Dr. Grover believes the approach is flexible enough to scale. “If a smaller hospital doesn’t have a video production team, a simple smartphone video can still make an impact,” she says.