Behavioral Health Issues — Determine Intervention — Clinical Pathway: Emergency

Behavioral Health Issues Clinical Pathway — Emergency Department

Determine Intervention

General

  • Safety of children and staff are a priority
  • Responses may be fluid based on severity of behavior and presenting concern
  • Start with least restrictive and coercive; approach varies based on level of agitation, potential for violence, and developmental level
  • Use trauma-informed care
  • Ask the caregiver what works and doesn’t work for the child
  • Employ environmental techniques immediately
  • Consider proactively offering a medication early on to reduce symptoms
  • Consult Child Life early
  • Utilize Psychiatric Technician leads for difficult cases

Non-pharmacologic Management

Environmental Modifications
  • Decrease environmental stimulation
  • Limit number of people in the room
  • Dim lights, soft music
  • Reduce noise, turn off alarms and monitors
  • Give personal space
  • Limit transitions
Distraction
  • Guided imagery
  • Distraction or diversion activities
  • Provide comfort items
  • Limit transitions
Consults
  • Child Life
  • Social Work
  • Psychiatry
  • Security
Communication
  • The caregiver at bedside is your best resource
    • Utilize one voice, multiple voices can be overstimulating
    • Set clear behavioral expectations
    • Offer choices, when appropriate
    • Practice reflective listening, demonstrate you understand
    • Validate feelings
    • Offer praise when positive behaviors are observed
    • Consider the developmental level of the child and alternate communication strategies
      • Picture cards
      • Sign language
      • Gestures
      • iPad/communication device

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