Browsing by Author "Foster, Ashley A."

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    Management of youth with suicidal ideation: Challenges and best practices for emergency departments
    (Wiley, 2024-04-03) Santillanes, Genevieve; Foster, Ashley A.; Ishimine, Paul; Berg, Kathleen; Cheng, Tabitha; Deitrich, Ann; Heniff, Melanie; Hooley, Gwen; Pulcini, Christian; Ruttan, Timothy; Sorrentino, Annalise; Waseem, Muhammad; Saidinejad, Mohsen; Emergency Medicine, School of Medicine
    Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self‐harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self‐harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home‐ and community‐based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on‐site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community‐ and home‐based services, pediatric‐receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.
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    Strategies for optimal management of pediatric acute agitation in emergency settings
    (Wiley, 2024-08-23) Saidinejad, Mohsen; Foster, Ashley A.; Santillanes, Genevieve; Li, Joyce; Wallin, Dina; Barata, Isabel A.; Joseph, Madeline; Rose, Emily; Cheng, Tabitha; Waseem, Muhammad; Berg, Kathleen; Hooley, Gwendolyn; Ruttan, Timothy; Shahid, Sam; Lam, Samuel H. F.; Amanullah, Siraj; Lin, Sophia; Heniff, Melanie S.; Brown, Kathleen; Gausche-Hill, Marianne; ACEP Pediatric Emergency Medicine Committee; Emergency Medicine, School of Medicine
    Acute agitation in youth is a challenging presentation to the emergency department. In many cases, however, youth can be behaviorally de-escalated using a combination of environmental modification and verbal de-escalation. In cases where additional strategies such as pharmacologic de-escalation or physical restraint are needed, using the least restrictive means possible, including the youth in the decision-making process, and providing options are important. This paper reviews specific considerations on the approach to a youth with acute agitation and strategies and techniques to successfully de-escalate agitated youth who pose a danger to themselves and/or others.