Protocols for Evaluation, Stabilization, and Care Coordination

• Trauma-Informed Care: Use protocols such as Trauma-Informed Care and DEF to mitigate distress and provide enhanced emotional support.
• Confidentiality: Conduct interviews with youth aged 12 and above separately from caregivers in private spaces.
• De-escalation: Use evidence-based approaches (e.g., CPI, Marcus, Welle) to manage agitation and reduce restraint use.
• Safety Checks: Ensure clothing, food, belongings, and the environment are free of harmful items.

Medical Clearance

• Conduct a full physical exam and review of systems to rule out medical causes of symptoms
• Treat any acute injuries and ensure chronic conditions are managed.
• Routine labs are not recommended unless clinically indicated (per APP, APA, ACEP guidelines). (2)

Mental Health Evaluation

• Performed by trained professionals (in person or via telehealth); RNs and physicians may assess suicide risk with training in a confidential.
• Use age-appropriate, validated screening tools (PHQ-9 for depression, GAD-7 for anxiety).
• Collect comprehensive history: presenting problem, treatment, family/social context, trauma, systems involvement, substance use.
• Conduct a mental status exam and assess risk and protective factors
• Gather collateral information from outpatient providers or schools when possible.

Suicide Risk Assessment

• Use tools such as:
  • SAFE-T: 5-step risk evaluation and triage
  • ASQ/BSSA: Per institutional protocol
• Assess intent, plan, behaviors, and protective factors
• Use results to determine risk level, safety needs, and treatment setting

When risk is identified:

• Develop a collaborative Safety Plan with the youth and family
• Address coping strategies, emergency contacts, and access to lethal means
• Use the plan to guide disposition and care planning.

• Prioritize evidence-based therapies: CBT, parent training, and symptom monitoring
• Avoid initiating medication unless urgently needed or restarting a known prescription.
• Match treatment intensity to clinical need

• Inpatient: Imminent danger, severe functional decline, unsafe, altered mental status

• Partial/IOP: Chronic risk without intent; impaired daily functioning

• Outpatient: Stable, can follow a safety plan, has support, and insight

• Define clear roles for ED staff, behavioral health, primary care, and school personnel
• Use standardized referral tools (e.g., warm handoffs, shared care plans)
• Assign a care coordinator to track referrals and close gaps
• Connect families to school-based, community, and peer supports