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Risk mitigation for children and young people in mental health crisis admitted to acute paediatric care: a mixed
Aikaterina Kaltsa1, Takawira C Marufu1,2, Tim Carter3
1Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Insights
This study identified 16 practical risk mitigation strategies to enhance safety for children and young people (CYP) experiencing mental health crises in pediatric care. These evidence-based strategies improve care consistency and safety for vulnerable youth.
Area of Science:
- Pediatric mental health
- Patient safety in acute care
- Risk management in healthcare
Background:
- Children and young people (CYP) experiencing mental health crises are increasingly admitted to acute pediatric care.
- There is a need for practical, evidence-based strategies to manage risks associated with these admissions.
- Current practices may lack consistency in addressing the unique safety needs of CYP in mental health crisis.
Purpose of the Study:
- To identify and prioritize actionable risk mitigation strategies for pediatric teams caring for CYP in mental health crises.
- To improve the safety and consistency of care for this vulnerable patient population.
- To provide clinicians with tools to tailor interventions based on assessed risk levels.
Main Methods:
- A sequential two-stage mixed-methods study involving a systematic review, qualitative interviews, and expert consensus.
- Utilized a hybrid Nominal Group Technique and modified Delphi process for strategy prioritization.
- Strategies were stratified according to clinical risk levels using a validated assessment framework.
Main Results:
- Identified 26 risk mitigation strategies, with 16 achieving expert consensus for clinical usefulness.
- Key strategies include structured safety checks, environmental modifications, therapeutic observation, timely specialist escalation, and multidisciplinary safety huddles.
- Strategies were mapped to risk levels, allowing for proportionate intervention.
Conclusions:
- Developed an evidence-informed, consensus-based set of risk mitigation strategies for immediate implementation in acute pediatric care.
- Embedding these strategies can enhance safety and consistency of care for CYP in mental health crisis.
- Empowers non-mental health clinicians to better manage pediatric patients presenting with mental health emergencies.
Objective:
This study aimed to identify and prioritise practical risk mitigation strategies that can be implemented by paediatric teams to improve the safety of children and young people (CYP) in mental health crises admitted to acute paediatric care.
Design:
A sequential two-stage mixed-methods exploratory study.
Setting:
UK acute paediatric hospitals/wards.
Participants:
16 Healthcare Professionals/CYP experts through experience.
Interventions:
None.
Main Outcome Measures:
In stage 1, risk mitigation strategies were identified through a systematic review and qualitative interviews followed by thematic analysis. In stage 2, strategies were prioritised using a hybrid Nominal Group Technique and modified Delphi process and stratified according to clinical risk level (low, medium, high, very high) using a validated paediatric mental health risk assessment framework.
Results:
26 risk mitigation strategies were identified, of which 16 achieved expert consensus (≥70%) for clinical usefulness. Clinically actionable strategies included: structured safety checks on admission and daily thereafter; proactive environmental modification to reduce triggers (noise, crowding, ligature risks); active 1:1 observation focused on therapeutic engagement rather than surveillance; prioritisation of timely assessment and escalation to specialist mental health services and routine use of multidisciplinary safety huddles. Strategies were mapped to risk level, enabling paediatric teams to tailor interventions proportionately to assessed risk.
Conclusions:
This study provides an evidence-informed, consensus-based set of risk mitigation strategies that can be implemented immediately within acute paediatric care. By embedding structured safety checks, therapeutic engagement and risk-informed environmental controls into routine practice, non-mental health clinicians can enhance safety and consistency of care for CYP admitted in mental health crisis.