Training Framework for PMHCAs Working with EDs

• Collaborate with EMS, pediatricians, other primary care providers, and schools to use shared screening tools and language.
• Provide a “What to Expect” handout for EMS to share with families or post on your website to help families prepare, covering topics like:
  • An overview of the ED process for mental and behavioral health screening.
  • What families should bring or know before arrival.
  • How caregivers can provide helpful background information that supports the assessment and care.
• Develop a referral pathway that outlines:
  • What information should EMS relay to the ED (e.g., presenting behaviors, recent events, known diagnoses)?
  • Who to contact in the ED for additional support or clarification.

Train triage and intake staff to:

• Recognize red flags and mental/behavioral health concerns in children and adolescents.
• Identify high-risk populations (e.g., children who have experienced traumatic events, children with autism spectrum disorders [ASD]).
• Use appropriate screeners:
  • Suicide risk: ASQ or C-SSRS
  • Aggression/violence risk: BRACHA, Broset
  • Substance use: CRAFFT

Ensure workflows address:

• Observation level (e.g., 1:1 monitoring)
• Environmental safety (removal of dangerous items, hospital-issued attire, avoiding utensils with food, etc.)
• Supportive triage best practices:
  • Prioritize history-taking with both the child patient and the caregiver, using trauma-informed, developmentally appropriate approaches (e.g., HEADSSS).
  • Work with interpreters trained in mental health terminology.
  • Use developmentally appropriate and confidential screening methods.
  • Support youth with ASD or sensory processing differences by moving patients to a safe, low-stimulation area.
  • Reassess frequently, especially during long wait times.
  • Activate escalation protocols for high-risk presentations (e.g., imminent harm, elopement risk), including security or mental/behavioral health teams as needed.

Medical screening should include:

• Physical exam and review of systems.
• Injury treatment and medical stabilization.
• Urine toxicology screen and/or pregnancy test, as needed.

Mental/behavioral health assessments should be:

• Conducted in a private space.
• Led by a pediatric-trained mental health provider or supported via telehealth.
• Comprehensive while addressing exposure to traumatic events, psychiatric history, family dynamics, substance use, and risk factors.

When in-person mental health providers aren’t available:

• Engage PMHCA consult lines for clinical guidance and planning.
• Use tools like SAFE-T or BSSA.

• Develop collaborative safety plans with families, not just forms.
• Provide lethal means counseling and distribute tools like lockboxes or safety brochures.
• Schedule follow-up care within 72 hours and confirm details with families prior to discharge.
• Maintain a list of hospitals with pediatric inpatient psychiatric services with admission criteria.
• Provide a staff checklist for transport, documentation, and family communication.

• Ensure ongoing patient safety (e.g., monitor for access to harmful items, assign 1:1 sitter if needed)
• Provide daily structure (e.g., meals, hygiene access, rest periods)
• Limit stimulation by removing personal devices if they are disruptive to the patient’s psychological well-being, but this should be done cautiously due to the high risk for escalation (and isolation from peer supports)
• Offer calming and distracting activities
• Continue regular reassessment, medication management, and safety planning efforts