4.55 WHAT ARE THE BEST PRACTICES AND REGULATIONS FOR PEDIATRIC PSYCHIATRY EMERGENCY CARE?

Objectives: Pediatric mental health emergency visits are increasing. In 2006, the American Academy of Pediatrics and the American College of Emergency Physicians issued a joint policy statement regarding pediatric psychiatric emergency patients. However, ED staff is rarely trained in mental health or systematic ways to assess risk factors, particularly for children. There are no published Best Practice guidelines for the evaluation and management of pediatric psychiatric emergency patients. In this review, we summarize the extant literature on models of care, standard practices, and regulatory body policies for emergency pediatric psychiatric care. Methods: A computer search of the published literature from 1946-through October 3, 2015 using Medline and PubMed identified 414 potential articles. A review of the titles and abstracts resulted in 56 articles to be included in the review. Results: A number of models are used in pediatric psychiatric emergencies: 1) community-based programs with intensive in-home supports 2) hospital-based clinic models linking to outpatient services 3) ED-based programs that evaluate and refer and 4) dedicated child and adolescent psychiatric emergency programs that provide brief stabilization and immediate follow-up. The evidence suggests a need for a combination of complementary models -- on a broader systems level, outreach services, crisis intervention teams, day and inpatient treatment, and within EDs, family-centered practice with parent/ patient guidance measures, triage systems to assess safety risk, staff training in de-escalation techniques, use of trained psychiatric interpreters, linkage services, and appropriations of physical space to accommodate youth mental health needs. Conclusion: There is no general consensus on the best model for providing pediatric psychiatric emergency care. However, there is evidence that implementing a specified model to better systematize care, and providing education may reduce length of stay in the emergency setting, unnecessary admissions, and recidivism. The field would benefit from the development of Practice Parameters for assessing and managing pediatric psychiatric emergency patients.