WRAP-EM Kids In Crisis Initiative

This initiative provides support to emergency departments and associated partners in their mitigation and management of the significant mental health surge from pediatric populations. Topics include acute trauma, suicidal ideation and attempts, neurological or developmental disorders, significant disruptive and aggressive behaviors, and children with “nowhere else to go.”

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Kids in Crisis: Video Playlist

Pediatric Mental and Behavioral Health Emergencies: Innovations and Resources to Address a Rising Crisis

This session will provide a high-level overview of several national HRSA-funded efforts to enhance pediatric mental health care. It will highlight the resources and initiatives developed by the EMS for Children Program to ensure the availability of critical resources -- educational products, QI collaboratives, quality measures, and research efforts -- to support the emergency care community in addressing pediatric mental health. These include Pediatric Education and Advocacy Kits (PEAK), Quality Improvement Collaborative (ED STOP Suicide) and the Pediatric Mental Health Care Access. The session will also provide a brief summary of the recently published joint policy statement on mental and behavioral health emergencies.

• EIIC – Pediatric Education & Advocacy Kit (PEAK): Suicide
• EIIC – ED Stop Suicide QI Collaborative: Resources
• EIIC – Pediatric Mental Health Care Access Program
• Journal of the American College of Emergency Physicians - Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting

Speakers

Dr. Kate Remick, MD, FAAP, FACEP, FAEMS

Dr. Moh Saidinejad, MD, MS, MBA, FAAP, FACEP

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Dr. Kate Remick, MD, FAAP, FACEP, FAEMS

Dr. Kate Remick is Co-Director of the EMS for Children Innovation and Improvement Center, Associate Chair for Quality, Innovation and Outreach and Associate Professor of Pediatrics at Dell Medical School at the University of Texas at Austin. In addition to her other roles, she is both a pediatric emergency medicine and EMS physician. Using quality improvement science as an underpinning of her work, Dr. Remick focuses on the readiness of emergency care systems to meet the needs of children. She has led numerous large-scale national quality improvement collaboratives to support the delivery of high-quality pediatric emergency care.

Dr. Moh Saidinejad, MD, MS, MBA, FAAP, FACEP

Mohsen Saidinejad is a Professor of Emergency Medicine and Pediatrics at the David Geffen School of Medicine at UCLA, and director of Pediatric Emergency Medicine at UCLA. He also serves as the director for the Institute for Health Services and Outcomes Research at the Lundquist Institute for Biomedical Innovation at Harbor UCLA. He also serves as the director of patient experience at Harbor UCLA Medical Center, department of emergency medicine. He has been involved in multiple national organizations, including being the past chair of the pediatric emergency medicine committee at ACEP, chair of the PEM interest group at SAEM, and is a currentMohsen Saidinejad is a Professor of Emergency Medicine and Pediatrics at the David Geffen School of Medicine at UCLA, and director of Pediatric Emergency Medicine at UCLA. He also serves as the director for the Institute for Health Services and Outcomes Research at the Lundquist Institute for Biomedical Innovation at Harbor UCLA. He also serves as the director of patient experience at Harbor UCLA Medical Center, department of emergency medicine. He has been involved in multiple national organizations, including being the past chair of the pediatric emergency medicine committee at ACEP, chair of the PEM interest group at SAEM, and is a current9 | P a g emember of the AAP COPEM. He is also one the domain leads for the HRSA funded knowledge management domain of the EMS for Children Innovation and Improvement Center (EIIC) and the Knowledge, Education, and Communication core of the Pediatric Pandemic Network (PPN), also funded by HRSA. Dr. Saidinejad has his research and advocacy concentration in pediatric mental health in the Emergency Department (ED), including ED-based interventions and has led the development of the Pediatric Education and Advocacy Kits for suicide and agitation for the EIIC. He is the lead author of the recently published AAP, ACEP, and ENA joint policy statement and technical paper on the role of emergency medicine clinicians in the assessment and treatment of children with acute mental and behavioral health presentations.

Bringing A Crisis into Focus – Telling the Story of Emergency Department Boarding

The pediatric mental health crisis has had impacts across our entire society, the impact on the emergency departments has been poorly understood from those outside of the ED walls. This presentation will discuss the significant impacts to patients seeking mental health care, emergency department capacity, and ED staff. Additionally, it will review what has been done to mitigate this crisis and how collecting data was imperative to focus statewide leaders on the scope of the problem and possible solutions.

Speakers

Dr. Bri Enriquez, MD

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Dr. Bri Enriquez, MD

Dr. Enriquez is a pediatric emergency medicine physician at Seattle Children’s. She is a Clinical Professor at the University of Washington in the Department of Pediatrics. She has been the Medical Director for Emergency Management at Seattle Children’s since 2011. She is heavily involved in pediatric statewide planning with the Northwest Healthcare Response Network (NWHRN). She developed a just-in-time pediatric capacity tool for the state and incorporated mental health boarding data as the crisis evolved. Seattle Children’s is one of 10 Children’s hospitals designated as a hub for the Pediatric Pandemic Network (PPN). She is active in the Western Regional Alliance for Pediatric Emergency Management (WRAP-EM). She is involved in all preparedness efforts for the region but has a particular interest in the areas of pediatric mental health and special pathogens.

ED-SAFE 2: Applying Continuous Quality Improvement to Suicide Prevention in the ED

This presentation will summarize the ED-SAFE 2 study, which used CQI to improve suicide screening and safety planning in 8 EDs across the country. Dr. Larkin will present on the implementation strategies used and the outcomes of the study.

 

Speakers

Dr. Celine Larkin, PhD

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Dr. Celine Larkin, PhD

Celine Larkin, PhD is committed to understanding and preventing suicide and other mental health conditions. For the past 15 years, she has drawn on the fields of psychology, health services research and implementation science to investigate better ways of identifying and responding to risk in diverse health care and community settings. Other topics of interest and experience include depression, tobacco, and alcohol use. As an emerging investigator, she seeks to continue this trajectory by leveraging evidence-based strategies and emerging technologies, such as machine learning, computer adaptive testing and technology-assisted implementation.

Integrated Mental Health Care and Zero Suicide: Providing Effective Change within the Chickasaw Nation’s Mental Healthcare System

This session offers a brief overview of the Chickasaw Nation’s two-pronged approach to mental healthcare system transformation with the concurrent implementation of integrated care and the Zero Suicide model. Both models have provided lasting effective change in the tribe’s large multi-site healthcare system in Oklahoma.

Speakers

Dr. Shannon Dial, PhD

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Dr. Shannon Dial, PhD

Dr. Shannon Dial received her PhD in Marriage & Family Therapy in 2014 and shortly after began her work for the Chickasaw Nation. Shannon currently works as the Executive Officer of the Integrated Services Division in the Department of Family Services. This includes oversite of:Dr. Shannon Dial received her PhD in Marriage & Family Therapy in 2014 and shortly after began her work for the Chickasaw Nation. Shannon currently works as the Executive Officer of the Integrated Services Division in the Department of Family Services. This includes oversite of:

•Medical Family Therapy – an Integrated Behavioral Health team in the tribe’s healthcare system

•Suicide Prevention Services – inclusive of two grants, one from Indian Health Service and one from SAMHSA and includes the tribe’s implementation of the Zero Suicide model

•A 5-year federal HRSA Pediatric Mental Health Care Access (PMHCA) grant focused increased access for children with mental health conditions and developmental disorders like autism•Family Services’ Clinical Informatics

Bringing Community into the Behavioral Health Continuum

Behavioral health crises come in many forms, and most do not fit neatly into a categorical service box. Learn how Mary Bridge Children’s Hospital engaged and leveraged community partnerships to create the community coalition Kids Mental Health Pierce County (KHMPC). This unique county-wide collaborative is dedicated to creating a coordinated pediatric behavioral health system that can respond to the individual needs of children and youth, particularly those in crisis. Hear how Kids Mental Health Pierce County transitioned from a local effort to a statewide initiative.

Please visit the Kids Mental Health Pierce County (KHMPC) website to learn more about the program: www.kidsmentalhealthwa.org

Speakers

Ashley Mangum, MSW, LICSW

Jamie Kautz, MSW, LICSW

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Ashley Mangum, MSW, LICSW

Ashley Mangum, LICSW, serves as the Director of Kids’ Mental Health Pierce County. Kids’ Mental Health - Pierce County is a community collaborative dedicated to developing a coordinated, responsive behavioral health system that serves the needs of children, youth, and families at the right time, in the best place, with the best outcome for every family.

Jamie Kautz, MSW, LICSW

Jamie Kautz, LICSW, is the Assistant Vice President of Pediatric Behavioral Health at Mary Bridge Children’s Hospital. Jamie has been serving the kids and families of Pierce County for the past 29 years.

School Connection: Links to Pediatric Mental Health Services

Snapshot of school-based pathways to mental health care for students in Sonoma County, CA. Overview of schoolSnapshot of school-based pathways to mental health care for students in Sonoma County, CA. Overview of school mental health supports, prevention/early intervention programs, referral process, and re-entry efforts.

Speakers

Rebekah Pope (she/her), LCSW, PPSC

Wendy Worms (she/her)

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Rebekah Pope (she/her), LCSW, PPSC

Rebekah Pope is a Licensed Clinical Social Worker who loves providing school-based mental health services and is passionate about helping schools meet the needs of their most vulnerable students. She has had the honor of providing a range of prevention, early intervention, and healing-centered supports in school settings over the course of her career, and is currently focused on county-wide suicide prevention efforts with the Sonoma County Office of Education. Rebekah coordinates Sonoma County’s System of Support, a network of volunteer crisis response agencies that responds to local schools in times of need.

Wendy Worms (she/her)

Wendy has worked at the intersection of education, mental health, and social justice for more than twenty years. An East Coast transplant, Wendy began teaching middle school in Oakland through Teach for America as a recent college graduate. She served as a teacher, school social worker, and program administrator in San Francisco, Oakland, and Mount Diablo Unified school districts before relocating with her family to Sonoma County in 2016. Wendy believes that school should offer all students a sense of belonging, hope, and agency – and that learning should be meaningful, relevant, and full of mistakes. Wendy is interested in building systems that nourish and sustain adults and students. At present, she focuses much of her work on the development of Wellness Centers in Sonoma County High Schools, and facilitating the Field Education Program to encourage and support the entrance of emerging clinicians into the world of schools.

Regional Child Psychiatric Emergency Centers

SAMHSA led the effort to implement 988 and noted the need for mobile crises services and stabilization centers to support success. While stabilization centers are available or underway for adults in many places around the United States, the pediatric strategy is less robust with minimal consensus on the right approach. This presentation will describe a proposal in Oregon building off of our well routinized trauma system in combination with regionalized networking with local communities and resources.

Speakers

Dr. Ajit Jetmalani, MD

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Dr. Ajit Jetmalani, MD

Ajit Jetmalani, M.D. is the Joseph Professor of Child and Adolescent Psychiatry Training and Division Director at Oregon Health & Sciences University. He has worked in most areas of the care continuum and is deeply involved in public policy efforts to improve behavioral health services for children and families in Oregon. He is consultant to the Oregon Health Authority and Oregon Department of Human Services Child Welfare as part of his position at OHSU.

The Behavior Safety Team: Helping Patients with Behavioral Risk Access Medical Care Safely

The Behavior Safety Team was established in 2011 to address concerns with patient and staff safety when children with behavioral risk required inpatient medical care. Using quality improvement methodology, we addressed the challenge, resulting in the development of a Behavior Safety Team, building from one psychologist consulting in inpatient medical units and growing to a 24/7 consultation service, safety system and Behavioral Response Team across inpatient, ambulatory and perioperative settings in 2 hospitals. The majority of patients served carry diagnosis of Autism and related disorders, although no specific diagnosis is required to access services. An overview of the components and effectiveness of this system and service will be discussed.

•Implementation of a Children’s Hospital Acute Care Behavior Response Team | Pediatrics | American Academy of Pediatrics (aap.org)

Employee and Staff Safety — Solutions for Patient Safety: Solutions for Patient Safety has workgroups focused on reducing patient behavioral events. They share a host of resources and encourage quality improvement methodology to drive effective system change.

Behavior Solutions in Hospitals ECHO » ECHO Autism: ECHOAutism.org:  provides many free webinars and trainings for providers, agencies and families to address the complex needs of individuals with autism. Using the Project ECHO model (Project ECHO - Moving Knowledge, Not People (unm.edu)) they hold a wide variety of cohorts using telehealth to support providers and agencies in developing the knowledge to improve systems of care. Of particular interest, the Behavior Solutions in Hospitals ECHO is available to provide free support to hospitals trying to build systems of care for autistic children under their care. This model involves a ½ day virtual didactic workshop followed 6 weeks of “clinics” that use brief didactics and case-based learning. Providers can earn CEU’s for their participation and are encouraged to get to know participants to build their network for ongoing problem-solving.

Speakers

Dr. Rena Sorensen

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Dr. Rena Sorensen

Dr Rena Sorensen is a clinical psychologist who specializes in the assessment and treatment of children with neurodevelopmental disorders and severe problem behavior. She joined Cincinnati Children’s in 2000 and has focused on providing intensive intervention services across multiple settings. She has developed home-based ABA, community consultation to schools and agencies, an intensive severe behavior treatment day-program, inpatient psychiatric stabilization for acute crisis management, and is currently the co-director of the nationally recognized Behavior Safety Team who serves patients admitted for medical care who have pre-existing behavioral challenges or who struggle to tolerate their care for any reason. She received the Richard M. Smith MD Leadership in Patient Safety Award from the Health Care Collaborative (2015), the Envisionary Award for Outstanding Leadership in Developmental Disabilities (2016), the Exemplary Therapist Award from the National Alliance on Mental Illness (2019), CHMC’s Compassionate Caregiver Award for the Behavior Safety Team (2021), and the CCHMC Senior Clinical Care Achievement Award in 2023.

Addressing the Youth Mental Health Crisis In (and Out of) Our Emergency Rooms

Reviewing the development of a Behavioral Health Urgent Care within the community as well as the creation of a strong partnership with school districts to transform the access to care for youth in the region.

Speakers

Dr. Victor Fornari, M.D., M.S.

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Dr. Victor Fornari, M.D., M.S.

Victor M. Fornari, M.D., M.S. is the Vice Chair, Child & Adolescent Psychiatry and the Director of the Division of Child & Adolescent Psychiatry at Long Island Jewish Medical Center, including the Zucker Hillside Hospital & the Cohen Children’s Medical Center. He is also Professor of Psychiatry & Pediatrics at the Donald & Barbara Zucker School of Medicine at Hofstra/Northwell.Victor M. Fornari, M.D., M.S. is the Vice Chair, Child & Adolescent Psychiatry and the Director of the Division of Child & Adolescent Psychiatry at Long Island Jewish Medical Center, including the Zucker Hillside Hospital & the Cohen Children’s Medical Center. He is also Professor of Psychiatry & Pediatrics at the Donald & Barbara Zucker School of Medicine at Hofstra/Northwell.In 2010, Dr Fornari participated in the development of CAP PC, Child & Adolescent Psychiatry for Primary Care, (Project TEACH) funded by the New York State Office of Mental Health to facilitate and collaborate with Primary Care Providers in the care of youth with mild to moderate mental health concerns. In 2017, Project TEACH was the recipient of the American12 | P a g ePsychiatric Association’s Psychiatric Services Achievement Bronze Award for Innovation.Dr. Fornari is an Investigator in a PCORI-funded Grant entitled START (Suicide Treatment Alternatives for Teens) to determine the most appropriate treatment for suicidal youth. (2019-2024)Dr. Fornari is the Co-Editor of the book Evidence Based Treatments for Eating Disorders: Children, Adolescent & Adults (Nova Science Press: 2009 & 2014) and well as the Editor of a book entitled: Psychiatric Nonadherence: A Solutions Based Approach (Springer, 2019), and a new book entitled: Pediatric Nonadherence: A Solutions Based Approach to be published early 2024 Springer Press.

Overview of SAFETY-A: A Therapeutic Assessment for Youth at Risk for Suicide in the Emergency Department

This presentation will be an overview of the SAFETY-A intervention (formerly called the Family Intervention for Suicide Prevention, FISP) will be provided; a therapeuticThis presentation will be an overview of the SAFETY-A intervention (formerly called the Family Intervention for Suicide Prevention, FISP) will be provided; a therapeutic assessment for suicidal youth and their families receiving services in the emergency department. Attendees will learn about the key pieces of SAFETY-A and evidence-based approaches to creating a developmentally informed and tailored safety plan. SAFETY-A is an evidence-based intervention that was originally designed for use in the emergency department and has since been disseminated to a variety of healthcare settings providing care to youth at risk for suicide.

The ABCDs of Screening & Management of Suicide Risk

Speakers

Dr. Lucas Zullo, PhD

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Dr. Lucas Zullo, PhD

Lucas Zullo, PhD is an Assistant Professor at Thomas Jefferson University in Philadelphia and the Clinical Director of the David Farber Advancement of Suicide Prevention, Intervention, Research, and Education (ASPIRE) Center. Dr. Zullo has a passion for community-partnered, equity driven care delivered through a trauma-informed lens. He is the co-leader of the NCTSN’s Trauma-Informed Suicide Prevention and Postvention Community of Practice. Dr. Zullo’s research focuses on quality improvement of clinical care, especially for improvement of care for LGBTQ+ youth at risk for suicide.

Seattle Children’s Telemedicine Extension for Adolescent and Child Mental Health Boarders (TEAM-B)

In response to the national pediatric mental health crisis, Seattle Children’s is creating the Telemedicine Extension for Adolescent and Child Mental Health Boarders (TEAM B) program to address the growing needs of youth who present to emergency departments in mental health crisis. This program will provide clinical consultation and resource assistance to our colleagues at community hospitals in need of support for their mental health boarders. We aim to reduce length of stay for youth boarding in emergency departments and support clinicians in providing more developmentally appropriate mental health care for youth while boarding. Our team will offer provider-to-provider consultation, including guidance on behavior management, medication strategies, and community mental health resources. In this presentation, we will discuss the background, development, and barriers to launching our program. We will also present preliminary results of a statewide needs assessment regarding pediatric mental health boarding in hospital settings.

•Telemedicine Extension for Adolescent and Child Mental Health Boarders Program (TEAM B)Telemedicine Extension for Adolescent and Child Mental Health Boarders Program (TEAM B)

•Mental Health Needs Assessment (TEAM B)

Speakers

Brooke Rosen, MD
Pauline Wray, MSW, LICSW

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Brooke Rosen, MD

Brooke is a child and adolescent psychiatrist at Seattle Children’s Hospital and an assistant professor in the University of Washington Department of Psychiatry and Behavioral Sciences. Clinically, she works with youth and families in acute care settings, including the Emergency Department, inpatient psychiatry unit, and medical floors. More broadly, she is dedicated to improving pediatric mental health systems of care to ensure equitable access to high-quality care for youth and young adults and is particularly interested in policy-based approaches to achieve this aim. She received grant funding this year to create a program that provides telehealth consultation to Emergency Departments and hospitals across the state to support increasing volumes of youth in mental health crisis, and she is fortunate to work with Pauline and several other dedicated colleagues to establish this model of care.

Pauline Wray, MSW, LICSW

Pauline is a Mental Health Therapist and the Program Manager for Seattle Children’s Telemedicine Extension for Adolescent and Child Mental Health Boarders (TEAM B). She received her Master’s in Social Work from Loyola University inPauline is a Mental Health Therapist and the Program Manager for Seattle Children’s Telemedicine Extension for Adolescent and Child Mental Health Boarders (TEAM B). She received her Master’s in Social Work from Loyola University inChicago, IL. Pauline is a Licensed Clinical Social Worker in Washington, Illinois, Virginia and Arizona and has spent her almost 20 year career in hospitals and outpatient clinics. She has extensive experience working with high risk patients and is particularly interested in crisis support, emergency medicine, suicidal ideation, and chronic illness. Through her vast experiences, Pauline has learned the power of collaboration and team work to facilitate the best possible patient outcomes and is fortunate to work with Brooke and several other passionate colleagues on this project. When not helping patients, Pauline enjoys traveling, exercising, reading, and spending time with her children and dogs.

Seattle Children’s Behavioral Health Crisis Care Clinic: An Outpatient Model of Care for Youth & Families in Suicidal Crisis

In 2019, the Seattle Children’s Behavioral Health Crisis Care Clinic (CCC) was launched to provide brief, just-in-time, outpatient care to youth presenting in a suicidal crisis. Since that time, nearly 300 families have received the CCC model of care, which consists of 4 cotreatment visits for patients and their caregiver(s), evidence-based intervention using the Collaborative Assessment and Management of Suicidality (CAMS), and robust care navigation support. This talk will provide an overview of the CCC treatment model, as well as lessons learned during clinic development, review of initial treatmentIn 2019, the Seattle Children’s Behavioral Health Crisis Care Clinic (CCC) was launched to provide brief, just-in-time, outpatient care to youth presenting in a suicidal crisis. Since that time, nearly 300 families have received the CCC model of care, which consists of 4 cotreatment visits for patients and their caregiver(s), evidence-based intervention using the Collaborative Assessment and Management of Suicidality (CAMS), and robust care navigation support. This talk will provide an overview of the CCC treatment model, as well as lessons learned during clinic development, review of initial treatment7 | P a g eoutcomes, and recommended future directions.

•American Psychological Association, Psychological Services - A Unique Model of Care for Youth in Crisis: A Pilot Open TrialAmerican Psychological Association, Psychological Services - A Unique Model of Care for Youth in Crisis: A Pilot Open Trial

•Child and Adolescent Mental Health - Review: Impact of Urgent Youth Outpatient Mental Health Care on Patient and Health System Outcomes – A Scoping Review

Speakers

Dr. Eileen Twohy, PhD

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Dr. Eileen Twohy, PhD

Dr. Twohy (she/her) is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. At Seattle Children’s Hospital, she is an attending psychologist on the Psychiatry Consultation/Liaison Team, co-leads the Crisis Care Clinic, and runs the Child Track of the UW Psychology Internship Program. Dr. Twohy’s interests include diversity and equity in psychology training and the provision of family-focused, least-restrictive intervention for suicidal youth.

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This Initiative was produced with the support and contributions of the WRAP-EM Mental Health Focus Group

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