Framework for Screening, Assessment, and Referral

Coordinating Care and Building Responsive ED Systems

Follow these steps to guide your conversations and explorations with the EDs you are engaging with. These steps serve as an excellent starting point to gain a better understanding of the current infrastructure and the processes that are already in place, as well as those that still need to be developed.

Core Steps

  • Use validated tools: PHQ-9, C-SSRS, ASQ
  • Assess for lethality, psychosis, or active safety risks
  • Low Risk: Passive thoughts, supports in place
  • Moderate Risk: Some planning or prior attempt
  • High Risk: Active Plan, impaired insight, or no support
  • Conducted by trained mental health professionals (on-site or remote)
  • Includes mental status, history of exposure to traumatic events, school, and family context
  • Involve caregivers unless contraindicated, following legal and ethical guidelines with consultation as needed
  • Address concerns, next steps, and provide support

Tailor to risk level and local context. The examples below are illustrative; each system should determine what is appropriate based on available resources and speed of access:

    • Low Risk: Outpatient and crisis plan, ensuring that caregivers are informed of the child patient’s status and next steps
    • Moderate Risk: Referral to a partial hospitalization program (PHP)/intensive outpatient program (IOP)
    • High Risk: Admission for inpatient care or 24-hour observation unit

Use navigators or social workers to:

  • Assist with transportation, insurance, and scheduling
  • Provide written safety plans and care summaries
  • Record screenings, assessments, communications, and plans
  • Track follow-up and revisit data for continuous improvement

PMHCA Checklist: Key Components of ED Mental Health Screening

Use this checklist to ensure your ED team has all the key components in place for effective pediatric mental health screening.

Download Checklist
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