Behavioral Escalations Clinical Pathway — Outpatient Specialty Care and Primary Care

Behavior Specific Response

Agitation/Aggression Risk Levels

Low	Medium	High
Lower demands Offer choices, such as breaks De-escalation Strategies	Provide clear, concise expectations Offer choices, such as ending the visit Remove potentially weaponized items Isolate escalating person, situation Alert Team Safe	Alert Team Safe Remove potentially weaponized items Isolate escalating person, situation Assess need to terminate visit

Elopement Risk Levels

Low	Medium	High
Position staff in front of the door, close door Comfort hold, or de-escalation strategies and resources	Position in front of the door, close door. Offer choices Taking a break Alert Team Safe	Alert Team Safe Position staff in front of the door, close door

Actively Suicidal/Self Harm Behaviors

For additional guidance refer to suicide pathway.

Low	Medium	High
Notify care team Members of the team should remain with person to monitor safety Provider ensures necessary coping skills and supports available for discharge Alert behavioral health provider on site, if available Notify existing therapist prior to discharge Additional guidance Suicide Risk Assessment and Care Planning Clinical Pathway Care of the Suicidal Patient in Ambulatory Care Locations Procedure	Alert Team Safe Members of the team should remain with person to monitor safety Evaluate the EOC for hazards and risks for items that could be weaponized Alert behavioral health provider on site, if available If no BH resource on site, contact on call SW Notify existing therapist prior to discharge Consider referral to ED or Crisis Center Refer to Care of Suicidal Patient Suicide Risk Assessment and Care Planning Clinical Pathway	Alert Team Safe Contact 911, immediately Members of the team should remain with person to monitor safety Alert behavioral health provider on site, if available If no BH resource on site, contact on call SW Evaluate the EOC for hazards and risks for items that could be weaponized Referral to ED or Crisis Center, children Consider appropriate legal and mental health dispositions in coordination with authorities, adults

Threat to Harm Others

Low	Medium	High
Notify Care Team Alert behavioral health provider on site, if available Contact for Additional Supports, as needed Social Work, Child Life, HMHK	Alert behavioral health provider on site, if available or Consider consulting behavioral health provider on site If no resource on site, contact on call BH or SW Alert Team Safe Contact 911, immediately Evaluate the EOC for hazards and risks for items that could be weaponized Consider Duty to Warn	Alert Team Safe Contact 911, immediately Consider consulting behavioral health provider on site If no resource on site, contact on call BH or SW Evaluate the EOC for hazards and risks for items that could be weaponized Consider appropriate legal and mental health dispositions in coordination with authorities, adults Consider Duty to Warn

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Behavioral Escalations Clinical Pathway — Outpatient Specialty Care and Primary Care

Behavior Specific Response

Agitation/Aggression Risk Levels

Elopement Risk Levels

Actively Suicidal/Self Harm Behaviors

Threat to Harm Others

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Behavioral Escalations — Behavior Specific Response — Clinical Pathway: Outpatient Specialty Care and Primary Care

Behavioral Escalations Clinical Pathway — Outpatient Specialty Care and Primary Care

Behavior Specific Response

Agitation/Aggression Risk Levels

Elopement Risk Levels

Actively Suicidal/Self Harm Behaviors

Threat to Harm Others