Contact for Additional Support

Collaborating with the person escalating to identify a support person or skills in de-escalation is encouraged.

Additional resources or supports may be important for the safety of staff and patients. Each resource comes with important considerations for staff to make. Confidence in resources available prior to an escalation may reduce staff hesitation leading to delayed support.

If staff/patient safety is of immediate concern, 911 should be contacted immediately.

Internal Resources
Access First Then Consider Resources Based on Availability

• Leadership (Nurse Leader, Office Manager, Medical Director)
  • Indications for call:
    • Limited staff resources for response.
    • Guidance needed for navigating resources and/or decision making.
    • General awareness.
  • Considerations:
    • If unable to notify immediately, contacting after the event is encouraged.
• Social Work
  • Indications for call:
    • Unable to complete required medical care.
    • Suspicion or concern for substances.
    • Limited capacity causing concern for safety.
    • Moderate to severe anxiety related to medical procedures.
    • Lacks effective coping skills and demonstrates little control over experiences or feelings.
  • Considerations:
    • If Social Work is not on site, recommend proceeding to External Resources for acute needs.
• CHOP Security
  • Indications for call:
    • Threat of physical injury.
    • Limited staff resources for response.
    • Suspicion or concern for substances or weapons.
    • Limited capacity causing concern for safety.

Child Life, HMHK, Outpatient BH resources may be available at sites or may be able to provide additional guidance to support or inform staff about patient behavioral needs or past de-escalation tools. Consider these resources, as needed for ongoing challenging behaviors.

External Supports

If patient safety is of concern and the patient is unable to return home with the caregiver present, it is recommended to contact both 911 and Child Protective Services to coordinate needed resources.

• 911, Police or EMS
  • Indications for call:
    • Concern for increasing escalation.
    • Limited staff to address safety needs.
    • Triage to identify needed resources for response.
  • Considerations:
    • When possible, person calling should provide clear description of the acute need and emphasize safety concern to ensure necessary resources are dispatched.
    • Mobile crisis may be available in certain counties, but 911 is encouraged for coordinating these resources.
    • Recommend mention:
      • History of prior behavior risk, injury.
      • Weapons (suggest stating yes, or unknown).
• Child Protective Services
  • Indications for call:
    • Patient safety is an immediate concern.
    • Caregiver is unable to safely leave with the child.
  • Considerations:
    • Covers all children < 18 years old.
    • Calling local agency is encouraged for immediate safety concerns.
    • Filing a report online may delay response, but may need to be completed after the event.
    • If a child is > 18 years old with a disability, Adult Protective Services.