| Child Life |
- Significant anxiety related to medical events.
- Challenging behaviors while in the healthcare environment.
- Unable to successfully complete required medical care.
- Lack effective coping skills and demonstrate little control over experiences or feelings.
- Have a substantial distortion of medical events or illness and/or lack understanding.
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- Phone call with caregivers to assess child and level of intervention needed.
- Preparation and coping resources for family and clinical team.
- Caregiver coaching to increase positive behaviors related to healthcare encounters.
- Close partnership with the primary care team.
- Referrals to other disciplines if necessary.
- In-person support during healthcare encounter if staffing allows.
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| Social Work |
- Acute or chronic emotional, behavioral, and social factors that might impact care.
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- Assessment to determine social factors that may impact behaviors and impact care.
- Behavioral health assessment to inform the most appropriate clinical treatment and/or immediate interventions.
- Appropriate referrals in partnership with the primary care team and conduct follow-up as appropriate.
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| Healthy Minds, Healthy Kids (HMHK) |
- Mild/moderate behavioral concerns
- Anxiety
- Mild/moderate depression
- ADHD
- Executive functioning needs
- School avoidance
- Injection fear
- Nurse staff may identify concerns to discuss with PCP/NP to determine if need meets level of care for HMHK or if SW referral to higher level of care required
- Referral ultimately made by PCP or NP
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- Referrals in advance of appointment are required.
- Brief Cognitive Behavioral Therapy typically performed in 8-10 sessions or less (dependent on level of need).
- Signed Consent to Treat is needed prior to making clinical recommendations directly to the family.
- Warm handoff- LCSW or psychologist on HMHK team in the office can be done on day of medical appointment. Consent should be obtained for scheduling evaluation for ongoing support.
- HMHK provider collaborates with PCP/NP to plan for future care.
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| Outpatient Behavioral Health |
- Acute or chronic emotional or behavioral health concern that requires being seen with more frequency than in office support can provide (see above for description of HMHK).
- Concern for crisis, more immediate need for care.
- Disruption in family system may cause barriers to implementing tools that would be taught in brief treatment setting (such as HMHK).
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- Psychology/LPC/LCSW — Licensed professionals in an outpatient setting trained to provide evidence-based therapy. Common treatment modalities include cognitive behavioral therapy, exposure and response prevention, and behavioral parent management training.
- Session length is typically 45-50 minutes, and will meet weekly or biweekly on more regular basis than brief treatment model.
- Psychiatry prescribes and manages medication if indicated as appropriate.
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| Sedation |
- Urgency of care
- Previous unsuccessful attempts to complete lab work, vaccines, or EKG
- Severity of response to previous attempts
- Safety risk to child or staff
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- Lack of available support in office by staff and guardians
- Anticipated number of staff needed to complete care not available in office
- Time constraints
- Ensure adequate details provided to address all child needs
- Consult triggers phone call to parent/ caregiver for evaluation and sedation plan. Primary care team orders tests, labs, vaccines, etc., to be completed on Sedation Unit
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