By Tiffany Ferguson, LMSW, CMAC, ACM
Over the years, my work has taken me into emergency departments and inpatient units across the country, often alongside social workers navigating some of the most complex and emotionally charged cases in healthcare. I’ve watched families deeply struggle and feel completely helpless in navigating the system while their child is experiencing suicidal ideation. I’ve seen social workers spend hours calling outpatient providers, attempting to find outpatient treatment and residential options, this is always difficult for adults, but even more so for children and adolescents. This work can sometimes consume the day on a singular case as they try to secure a follow-up appointment that aligns with both clinical urgency and the family reality of transportation needs and options in their own communities. Too often, despite best efforts, these appointments or placements end up with waitlists or appointments weeks or even months away.
During a recent visit to a children’s hospital in Florida, those familiar challenges resurfaced yet again. Not long after, I was reminded of an email I had received from a colleague, Dr. Hirsch, flagging a report released earlier this year by the HHS Office of Inspector General. At the time, it was overshadowed by other CMS updates. In hindsight, its findings are far too important for case managers and social workers to overlook.
Why This Report Matters Now
Released in September 2025, the OIG report examined how frequently children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) receive follow-up care after hospitalization or emergency department (ED) visits for suicide-related concerns.
Suicide is now the second leading cause of death among U.S. children and adolescents ages 10–17, with rates of suicidal thoughts and behaviors rising sharply over the past decade. In 2023 alone, nearly 225,000 insured youth in this age group were treated in hospitals or EDs for suicidal ideation or behavior.
The period immediately following discharge, particularly the first seven days, is widely recognized as a time of extraordinarily high risk for repeat attempts or suicide death. Timely follow-up care during this window not only reduces rehospitalizations and emergency department utilization but can save lives.
Using Transformed Medicaid Statistical Information System (T-MSIS) data, the OIG identified several concerning trends. They found that 50% of pediatric patients hospitalized or treated in the ED for suicidal thoughts or behaviors did not receive a follow-up visit within seven days of discharge. They also noted that 21% had no follow-up care at all within 60 days, despite ongoing elevated risk. When follow-up visits did occur, 71% were provided by behavioral health specialists, including counselors, social workers, psychiatrists, psychologists, and psychiatric nurse practitioners. The remainder were delivered by clinicians such as pediatricians or care managers.
These findings confirm what I imagine many CMSA members experience daily: timely behavioral health follow-up for children and adolescents are inconsistent, fragmented, and heavily dependent on factors outside the hospital’s control.
To understand why follow-up rates remain low, the OIG interviewed subject-matter experts from organizations including SAMHSA, the American Foundation for Suicide Prevention, and the National Alliance on Mental Illness. Two primary barriers emerged. First, the behavioral health workforce shortage continues to limit access nationwide. More than 120 million Americans live in federally designated mental health professional shortage areas, with wait times for appointments often stretching weeks or months. Second, families frequently encounter system navigation challenges. Discharge planning may not include scheduled appointments, and caregivers may face transportation barriers, stigma, insurance complexity, or difficulty coordinating care for a child already in crisis.
Implications for Case Management Practice
For case managers and social workers, the report reinforces the critical importance of care transitions for pediatric behavioral health patients. The OIG highlighted several strategies that can help close gaps in care:
- Brief “bridge” interventions, such as post-discharge outreach or caring contacts
- Warm handoffs between inpatient or ED teams and outpatient behavioral health providers
- Clear, understandable safety planning that actively involves both the child and their caregivers
For CMSA members, this report serves as both validation and a call to action: to continue pushing for staffing models, workflows, and community partnerships that support seamless behavioral health transitions for children and adolescents when they are most vulnerable.
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Bio: Tiffany Ferguson, MSW, ACM, CMAC is CEO of Phoenix Medical Management, Inc. Tiffany serves as an adjunct professor at Northern Arizona University, Department of Social Work, and on the American College of Physician Advisors (ACPA) Observation Committee. Tiffany is co-author of The Hospital Guide to Contemporary Case Management through HcPro. She is a contributor for RACmonitor and Case Management Monthly; she also serves on the editorial board for CMSAToday and Care Management. She is a weekly correspondent on SDoH for the news podcast Talk Ten Tuesday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles in Health & Care Management, which includes CM, UR, CDI, HIM, and coding. She has held C-level responsibility for a large employed medical group which included value-based arrangements and outpatient care management. Tiffany is a graduate of Northern Arizona University and received her MSW at UCLA.