Putting Protocols into Practice

These sample workflows demonstrate how multidisciplinary teams apply pediatric behavioral health protocols in real-world ED scenarios. Each case highlights step-by-step actions, practical tools, and strategies that support safe, family-centered care. By reviewing these examples, PMHCAs and ED staff can see how evidence-based approaches are adapted to meet the unique needs of various patients.

Scenario:
11-year-old boy with a diagnosis of ASD and non-verbal communication transferred via EMS from school due to kicking staff and inability to be soothed using historically successful interventions.

Workflow Summary:

• Triage: Use visual supports, dim lights, quiet space
• Screening: Skip verbal tools, rely on caregiver input, and observe behavior
• Assessment: Pediatrician and behavioral consultant coordinate care
• Intervention: Avoid restraints, introduce sensory items such as a weighted blanket
• Disposition: Return home with crisis plan, follow-up through developmental pediatrics

Tools Applied:

• Non-verbal de-escalation guide
• Sensory-friendly room setup protocol
• ASD-specific discharge planning checklist

Scenario:
A 15-year-old girl was brought in by a parent after texting “I can’t do this anymore.” No prior behavioral health history.

Workflow Summary:

• Screening: C-SSRS indicates moderate risk
• Medical Clearance: Labs, vitals, pregnancy test
• Consultation: ED team consults with PMHCA psychiatry consult line
• Safety Planning: Collaborative plan built with the teen and caregiver
• Disposition: Follow-up in 48 hours with a telehealth provider

Tools Applied:

• PMHCA telepsychiatry consult line script
• Lethal means counseling template