Child Management in the APS

Nina Muriel and James Waxmonsky

1. Format for Assessment

A. Ensure the safety of patient: resolve acute agitation (see protocol) and any acute medical concerns (transfer to pedi ER if necessary)

B. Obtain history and complete the APS child assessment form

C. Initiate contact with the available collateral sources (school, therapist, psychiatrist, etc.).

D. Present the case to your APS supervisor.

E. Decide if child psychiatry needs to be contacted and what specific concerns you would like the child psychiatrist to address. Please finish steps A through D BEFORE contacting child psychiatry.

F. Devise a formulation.

G. Implement a disposition (see hospitalization protocol if needed)

2. When to Contact Child Psychiatry

- EVERY case involving a patient ages 10 or under

- Any patient that will be boarded on pediatrics (The child psychiatry consult team must be notified of all pediatric boarders.)

- Otherwise, at your discretion

3. How to Contact Child Psychiatry

During the child workday, (9:00am to 5:00pm on Monday-Friday)

- Call 6-2727.

- A child psychiatrist will then be assigned and will quickly contact the identified APS clinician.

After the workday, (after 5:00pm on weekdays or anytime on weekends/holidays)

- Consult the child psychiatry call schedule posted in the APS.

- Page the fellow who is covering for that night. If necessary, the child fellow on call will discuss the case with the attending child psychiatrist. This fellow is responsible for contacting the child psych consult team the next morning to ensure follow-up on boarders.

4. Child disposition options

In lieu of inpatient level of care, also consider:

- Family stabilization team (accessed through MBHP)

- partial hospitalization

- Acute Residential Treatment, as well as the inpatient levels of care.

When no beds are available, MGH Pediatrics or the APS will admit the patient as a “boarder.” In these cases, go ahead and get authorization for hospital level of care with MBHP (or other insurer)

APS Child Evaluation

See Child Evaluation Forms in the APS; don’t call the child fellows without completing a form. Contact information (for guardian or parent, PCP, etc.) is particularly essential.

Additional elements to be included in the evaluation include:

1. Past psychiatric history:

Other levels of care: ART, Crisis stabilization, partial hospitalization, FST

2. PMH:

Sexually active?

Immunization history

3. Social history:

** Legal guardian:

** If guardian not available, who authorizes care?

Family members, other caregivers

DSS involved? (Case open or closed?)

CHINS filed?

Legal issues?

School, grade

Special services?

CORE/IEP

Special education?

4. Mental status exam

Interaction with caregiver

Tics

Pediatric and Adolescent Psychiatric Units

Acute Residential Treatment Programs