Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Behavioral Health Concerns

Goals and Metrics
Provider Resources
Red Flags
ED Patients with Behavioral Health Concerns
Mood/Behavior Risk Level ≥ 8 Years of Age < 8 Years of Age Action
All suicide risk levels and aggression:
Page Social Work on call
Place RED EPIC Security Flag
Expedite to ED Room, use BH Rooms as able
Suicide Acute
  • ASQ: Yes to question 5
  • Patient refuses ASQ
  • Active suicidal ideation or attempt
  • Parent/guardian reported suicidal ideation or attempt within last day
  • Active suicidal ideation or attempt
  • Parent/guardian reported suicidal ideation or attempt within last day
  • Immediate Safety Observation with CHOP Staff Observer
Non-acute
  • ASQ: Yes to any question 1-4
  • Parent/guardian reported suicidal ideation or attempt within last month
  • History of suicidal ideation or self-harm in the last month
  • Parent/guardian reported suicidal ideation or attempt within last month
 Immediate Safety Observation with CHOP Staff Observer until formal risk assessment completed
Negative Screen ASQ: "No" to all questions No history for suicidal ideation or self-harm Review considerations below for potential Safety Observation need
Aggression Acute
  • Active physical aggression towards self, others or property
  • Active verbal aggression
  • Consider need for Safety Observation with CHOP Staff Observer
  • Notify Security
Non-acute Calm but history of aggressive behavior Review considerations below for potential Safety Observation need
  • Patients presenting with other behavioral health concerns may need Safety Observation and/or other safety practices
  • Patients presenting from inpatient psychiatric facility: perform ASQ and initiate Safety Observation by CHOP staff regardless of screen result
  • Patients in law enforcement custody with behavioral health concerns: initiate Safety Observation by CHOP staff per risk level, notify security
Disposition
Inpatient Medical Admission
EDECU, Awaiting Inpatient Psychiatric Transfer
Inpatient Psychiatric Admission
Discharge
  • Ensure 201 or 302
  • Transport Form Signed by ED
    • Attending
  • Ensure Belongings with Patient
  • Child Life and Team Prepares
    • Patient for Transfer
  • Safety Observation
  • Safety Plan
  • Partial Program
  • Outpatient Referral
  • Community Resources
  • Ensure Belongings with Patient
Posted: February 2013
Revised: October 2022
Authors: J. Lavelle, MD; M. M'Farrej, MD; J. Esposito, MD; A. Jhonsa, MD; E. Perry, MSW; K. White, MSW; E. Steinmiller, RN; A. Felix, CRNP; K. Crescenzo, RN; MK. Abbadessa, ACCNS-P; A. Fu, MD; C. Jacobstein, MD; K. Osterhoudt, MD; E. Friedlaender, MD