Camhs Risk Assessment Tool | Simulation Scenario – Adolescent Risk Assessement 232 개의 자세한 답변

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This video demonstrates an adolescent psychiatric risk assessment, focussing on risk of suicide and self harm and assessment of mental state. This could be used prior to simulation training as a stand-alone or part of a course to demonstrate best practice.
For more clinical simulation resources please visit http://ww2.clinsim.health.wa.gov.au/

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RISK SCREENING ASSESSMENT – Policies

(Conseration must be given to the potential risks posed by family members/carers to other people (children and adults) in the family network.

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Source: policies.sussexpartnership.nhs.uk

Date Published: 1/6/2022

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Self-Harm and CAMHS

Early entification of mental health needs – … CAMHS RRT Crisis Stabilisation Pathway. Crisis presentation … Is there a suice risk assessment tool in.

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Source: www.southeastclinicalnetworks.nhs.uk

Date Published: 1/5/2021

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Clinical Risk Assessment and Management – UCL

competencies and should be read as part of the CAMHS competency framework. … An ability to draw on knowledge that risk assessment tools may be a useful …

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Source: www.ucl.ac.uk

Date Published: 3/18/2022

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Children and Young People Mental Health Risk Guideline

Children and Young People Mental Health Risk Gueline. Clinician name: … formal risk assessment by PMHLT is indicated … community CAMHS team or GP.

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Source: www.bsuh.nhs.uk

Date Published: 3/23/2022

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Validation of Risk Assessment tools in CF-CAMHS

Valation of Risk Assessment tools in CF-CAMHS … who access Forensic Child and Adolescent Mental Health Services in the community.

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Source: www.hra.nhs.uk

Date Published: 10/2/2022

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Children and Young People-Mental Health Safety … – BMJ Open

Aim The aim of this study is to develop and test the psychometric properties of an assessment tool that entifies immediate risk of self-harm and suice in …

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Source: bmjopen.bmj.com

Date Published: 5/15/2022

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CAMHS Risk Assessment and Management – HEE NE

Risk Assessment is a core component of mental health care. ○ This includes children and young people. Page 10. Safeguarding.

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Source: madeinheene.hee.nhs.uk

Date Published: 12/18/2022

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주제와 관련된 이미지 camhs risk assessment tool

주제와 관련된 더 많은 사진을 참조하십시오 Simulation Scenario – Adolescent Risk Assessement. 댓글에서 더 많은 관련 이미지를 보거나 필요한 경우 더 많은 관련 기사를 볼 수 있습니다.

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주제에 대한 기사 평가 camhs risk assessment tool

• Author: Western Australian Clinical Training Network
• Views: 조회수 74,143회
• Likes: 167407 Like
• Date Published: 2016. 8. 3.
• Video Url link: https://www.youtube.com/watch?v=wNF1FIKHKEU

What tools are used for risk assessments?

The four common risk assessment tools are: risk matrix, decision tree, failure modes and effects analysis (FMEA), and bowtie model. Other risk assessment techniques include what-if analysis, failure tree analysis, and hazard operability analysis.

What is a risk assessment in mental health?

What is risk assessment? Risk assessment combines consideration of psychological and social factors as part of a comprehensive review1 to capture patient care needs, and to assess their risk of harm to themselves or others. Assessments often aim to categorise patients as at high, medium or low risk.

What is Warrn assessment?

Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services.

Is risk a assessment?

Risk assessment is a term used to describe the overall process or method where you: Identify hazards and risk factors that have the potential to cause harm (hazard identification). Analyze and evaluate the risk associated with that hazard (risk analysis, and risk evaluation).

What are the 5 types of risk assessment?

What is the best risk assessment tool?

How do you start risk assessment?

Where do you start a risk assessment?

How do you write a mental health risk assessment?

What is the HCR 20 used for?

The HCR-20 is a 20-item structured clinical guide for the assessment of violence risk intended for use with civil psychiatric, community, forensic, and criminal justice populations.

What are the three types of risk assessments?

What is the first step in a risk assessment?

Identifying and locating any potential hazards is the first step when carrying out a risk assessment. Several different types of hazards should be considered. Physical risks include tripping or falling in the workplace, sustaining injuries when lifting heavy materials or working with dangerous machinery.

Who can write a risk assessment?

Who is responsible for the completion of risk assessments? It is the responsibility of the employer (or self-employed person) to carry out the risk assessment at work or to appoint someone with the relevant knowledge, experience and skills to do so.

Which tool is used for risk management?

SWOT. SWOT, or strengths, weaknesses, opportunities, threats, is another tool to help with identifying risks.

What are the four risks control tools and techniques?

Identifying new risks. Evaluating current risks. Evaluating the risk management processes. Closing risks.

Which tool is most commonly used in risk identification process?

1. Risk analysis questionnaire. This is one of the most widely used risk identification methods. The questionnaire develops a series of questions whose objective is to determine the possibility of occurrence of some situations that could generate losses.

What are the risk assessment techniques?

Process, Examples & Tools

A risk assessment is a systematic process that involves identifying, analyzing and controlling hazards and risks. It is performed by a competent person to determine which measures are, or should be, in place to eliminate or control the risk in the workplace in any potential situation.

Risk assessment is one of the major components of a risk analysis. Risk analysis is a process with multiple steps that intends to identify and analyze all of the potential risks and issues that are detrimental to the business. This is an ongoing process that gets updated when necessary. These concepts are interconnected and can be used individually.

Risk communication is the process of exchanging information and opinion on risk to concerned parties. Risk management is the proactive control and evaluation of threats and risks to prevent accidents, uncertainties and errors. Together with risk assessment, these are all vital elements that help make informed decisions such as mitigating risks.

Why Is Risk Assessment Important?

Identifying hazards by using the risk assessment process is a key element when ensuring the health and safety of your employees and customers. OSHA requires businesses to conduct risk assessments. According to regulations set by OSHA, assessing hazards or potential risk will determine the personal protective gears and equipment a worker may need for their job. There are guidelines available for different industries since present types of possible risks may vary, an example of this is agribusinesses. Unique risks for this industry include manure storage, tractor operation, animal handling, behavior, and health.

The Environmental Protection Agency (EPA) of the US specializes in assessing hazards related to humans and its environmental receptors such as animals, chemicals, and other ecological factors. While in the UK, conducting risk assessments are a legal requirement as stated in the Health and Safety at Work Act. The specific regulation under this law can be retrieved from the Management of Health and Safety at Work Regulations Section.

The gravity of hazard identifications is clear with all these organizations and governments requiring risk assessments at work. Prevent and reduce risks to save lives and to ensure that the workplace stays as a safe space.

When Do You Perform a Risk Assessment?

Beyond complying with legislative requirements, the purpose of risk assessments are to eliminate operational risks and improve the overall safety of the workplace. It is employers responsibility to perform risk assessments when:

new processes or steps are introduced in the workflow;

changes are made to the existing processes,

equipment, and tools; or new hazards arise.

Risk assessments are also performed by auditors when planning an audit procedure for a company.

Difference Between Risk Assessment and Job Safety Analysis (JSA)

Risk assessments are often confused with a Job Safety Analysis (JSA) or Job Hazard Analysis (JHA). The key difference between a risk assessment and a JSA is scope. Risk assessments assess safety hazards across the entire workplace and are oftentimes accompanied with a risk matrix to prioritize hazards and controls. Whereas a JSA focuses on job-specific risks and are typically performed for a single task, assessing each step of the job.

3 Types

While the exact details of risk assessments may vary greatly across different industries, HSE distinguishes three general risk assessment types:

Large Scale Assessments

This refers to risk assessments performed for large scale complex hazard sites such as the nuclear, and oil and gas industry. This type of assessment requires the use of an advanced risk assessment technique called a Quantitative Risk Assessment (QRA).

Required specific assessments

This refers to assessments that are required under specific legislation or regulations, such as the handling of hazardous substances (according to COSHH regulations, 1998) and manual handling (according to Manual Handling Operations Regulations, 1992).

General assessments

This type of assessment manages general workplace risks and is required under the management of legal health and safety administrations such as OSHA and HSE.

Examples

Risk assessments are essential to identify hazards and risks that may potentially cause harm to workers. There are a variety of risk assessments used across different industries tailoring specific needs and control measures. Here are common risk assessment examples:

Health and Safety Risk Assessment – a type of risk assessment used by safety managers to determine health and safety risks associated with the job, work environment, and current processes. Hazards can be identified as biological, chemical, energy, environmental, and the like.

Workplace Risk Assessment – performed by office managers and school administrators, this tool helps ensure that a workplace is free from health and safety threats. This assessment also helps boost employee morale and productivity.

Fall Risk Assessment – performed by nursing staff of aged care units or centers to evaluate the possibility of falling. This checklist will ensure that the facilities, equipment, and other factors are safe for elderly patients.

Construction Risk Assessment – a vital assessment used in the construction site to help safety teams implement corrective measures and stakeholders comply with safety regulations.

Risk assessments can be seen as a regulatory paperwork burden, but understanding the reason and purpose of a risk assessment will help your team identify, prioritize and control hazards in your workplace.

Create Your Own Risk Assessment Checklist Automate workflows and streamline operations with this checklist today. Get started for free

Planning

Risk assessments should be carried out by competent persons who are experienced in assessing hazard injury severity, likelihood, and control measures. To start off, good planning will be essential in order to implement a risk assessment effectively. Consider the following 4 elements as stated by the Occupational Safety and Health Administration (OSHA):

What is your scope?

Determining the scope when planning your risk assessment can help you figure out what resources you would need. Be specific about what you’re assessing. Are you assessing a product? An organizational process? Or a workplace area? What resources do you need?

Determine the kind of training, tools, and equipment your team needs to effectively carry out the risk assessment. You should also determine the risk analysis measures you are going to use and know why they are the best choice for your purpose. Who is involved?

Note the personnel involved in your risk assessment planning and implementation. They could be managers, supervisors, workers, or suppliers. This helps you identify additional resources that can help you improve the effectiveness of your risk assessment. What laws, regulations, and internal policies do you need to comply with?

Non-compliance could lead to hefty fines and other offenses that can spell trouble for your operation. Determine the laws, regulations, codes, standards, and internal policies you need to consider when conducting your risk assessment.

By determining all of these, you can create a solid foundation for an effective risk assessment. Once you’ve planned out your risk assessment, you can proceed with performing the risk assessment. A risk assessment is performed in 5 steps or stages.

5 Steps

1. Identify hazards

Survey the workplace and look at what could reasonably be expected to cause harm. Identify common workplace hazards. Check manufacturers or suppliers instructions or data sheets for any obvious hazards. Review previous accident and near-miss reports. Efficiently identify hazards by using a hazard identification checklist. This ensures everything is covered during risk assessment and hazard identification which prevents risks from escalating.Hazards and risks are sometimes used interchangeably; however, they actually refer to two different elements of a potential incident. A hazard is something that has the potential of causing harm to people, property, or the environment, while risk is the likelihood of a hazard to actually cause harm or damage under defined circumstances.

2. Evaluate the risks

To evaluate a hazard’s risk, you have to consider how, where, how much and how long individuals are typically exposed to a potential hazard. Assign a risk rating to your hazards with the help of a risk matrix. Using a risk matrix can help measure the level of risk per hazard by considering factors such as the likelihood of occurrence, and severity of potential injuries. Meanwhile, performing an environmental analysis lets you gauge potential risks and their impacts on your business environment.

3. Decide on control measure to implement

After assigning a risk rating to an identified hazard, it’s time to come up with effective controls to protect workers, properties, civilians, and/or the environment. Follow the hierarchy of controls in prioritizing implementation of controls.

4. Document your findings

It is important to keep a formal record of risk assessments. This can help your organization keep track of hazards, risk, and control measures. Documentation may include a detailed description of the process in assessing the risk, an outline of evaluations, and detailed explanations on how conclusions were made.

Use a risk assessment template to document your findings. Get started with iAuditor’s free risk assessment templates that you can use on your mobile device while on-site. Share your report and findings with key parties who can implement changes.

5. Review your assessment and update if necessary

Follow up with your assessments and see if your recommended controls have been put in place. If the conditions in which your risk assessment was based on change significantly, use your best judgment to determine if a new risk assessment is necessary.

There are options on the tools and techniques that can be seamlessly incorporated into a business’ process. The four common risk assessment tools are: risk matrix, decision tree, failure modes and effects analysis (FMEA), and bowtie model. Other risk assessment techniques include what-if analysis, failure tree analysis, and hazard operability analysis.

How to use a Risk Matrix?

Likelihood Very Likely Likely Unlikely Highly Unlikely Consequences Fatality High High High Medium Major Injuries High High Medium Medium Minor Injuries High Medium Medium Low Negligible Injuries Medium Medium Low Low

A risk matrix is often used during a risk assessment to measure the level of risk by considering the consequence/ severity and likelihood of injury to a worker after being exposed to a hazard. The two measures can then help determine the overall risk rating of the hazard. Two key questions to ask when using a risk matrix should be:

Consequences: How bad would the most severe injury be if exposed to the hazard? Likelihood: How likely is the person to be injured if exposed to the hazard?

The most common types are the 3×3 risk matrix, 4×4 risk matrix, and 5×5 risk matrix.

How to Assess Consequences?

In assessing the consequences of a hazard, the first question should be asked “If a worker is exposed to this hazard, how bad would the most probable severe injury be?”. For this consideration we are presuming that a hazard and injury is inevitable and we are only concerned with its severity.

It is common to group the injury severity and consequence into the following four categories:

Fatality – leads to death

– leads to death Major or serious injury – serious damage to health which may be irreversible, requiring medical attention and ongoing treatment

– serious damage to health which may be irreversible, requiring medical attention and ongoing treatment Minor injury – reversible health damage which may require medical attention but limited ongoing treatment). This is less likely to involve significant time off work.

– reversible health damage which may require medical attention but limited ongoing treatment). This is less likely to involve significant time off work. Negligible injuries – first aid only with little or no lost time.

To illustrate how this can be used in the workplace we will use the example of a metal shearing task. A hazard involved could include a piece of metal flying out of the equipment while in use. In this example the probable most severe injury would be “Major or Serious Injury” with the possibility of bruising, breakage, finger amputation.

How to Assess Likelihood?

In assessing the likelihood, the question should be asked “If the hazard occurs, how likely is it that the worker will be injured?”. This should not be confused with how likely the hazard is to occur. It is common to group the likelihood of a hazard causing worker injury into the following four categories:

Very likely – exposed to hazard continuously.

– exposed to hazard continuously. Likely – exposed to hazard occasionally.

– exposed to hazard occasionally. Unlikely – could happen but only rarely.

– could happen but only rarely. Highly unlikely – could happen, but probably never will.

In our metal shearing example the question should not be “How likely is the machine expected to fail?” but instead “When the machine fails and causes metal to fly out, how likely is the worker expected to be injured?”. If in our example we observe a safe distance between the machine and worker and proper PPE being worn, we could rate it as “Unlikely” given our observations

We recommend OSHA’s great learning resources in understanding how to assess consequence and likelihood in your risk assessments.

Risk Assessment Training: Achieving a Culture of Safety

“Safety has to be everyone’s responsibility… everyone needs to know that they are empowered to speak up if there’s an issue.” – Captain Scott Kelly, at the SafetyCulture Virtual Summit.

Thinking about safety shouldn’t stop at the completion of a risk assessment. Embody a safety culture, that way employees are empowered to be greatly aware and conscious of their safety as they do their best work. A hazard identification and risk assessment training can help your organization achieve that.

A good and effective risk assessment training should orient new and existing employees on various hazards and risks that they may potentially encounter. It should also be able to walk them through safety protocols. When everyone is on the same page, managing risks becomes easy.

Conducting or providing training shouldn’t be a pain. With today’s technology, many mobile applications allow you to transform training into engaging and bite sized lessons. Below are a few courses we picked out that can be beneficial for you in getting started:

How do you Perform a Risk Assessment with iAuditor?

Many factors and processes can come into play when conducting a risk assessment. The process usually takes a lot of time as it involves going through multiple hands for review and completion. Which in turn, opens the whole risk assessment procedure to issues like losing track of paperwork and records.

Using a risk assessment software like iAuditor makes it easy for you to have everything in one place. Organizations are able to track hazards, risks, control measures, and corrective actions within just a few taps.

See how iAuditor can help your risk assessment every step of the way:

Identify hazards

Using your mobile or tablet device, survey the workplace and list down risks and hazards you’ve identified. Provide better understanding of the risks and hazards, by attaching or capturing photo evidence within the app during inspection. Evaluate the risks

Risk and hazards identified, can be assigned the appropriate risk rating and control measures then and there. Image references can be included within the risk assessment form for users to base on for a more accurate rating. Assigning control measures

Be proactive by not only listing down the appropriate control measure for each risk, iAuditor enables users to assign corrective actions so action items are immediately resolved instead of piled up. Recording your risk assessment

Comprehensive reports are automatically generated after completion of the risk assessment forms. They can be shared in word, pdf or by link across your team members and others. Reviewing and updating your risk assessment

Risk assessment documents are instantly and securely saved in your account, ready for you to access and update whenever you need to.

WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country

Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the “common-language” created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result.

Risk Assessment : OSH Answers

Ranking or prioritizing hazards is one way to help determine which risk is the most serious and thus which to control first. Priority is usually established by taking into account the employee exposure and the potential for incident, injury or illness. By assigning a priority to the risks, you are creating a ranking or an action list.

There is no one simple or single way to determine the level of risk. Nor will a single technique apply in all situations. The organization has to determine which technique will work best for each situation. Ranking hazards requires the knowledge of the workplace activities, urgency of situations, and most importantly, objective judgement.

For simple or less complex situations, an assessment can literally be a discussion or brainstorming session based on knowledge and experience. In some cases, checklists or a probability matrix can be helpful. For more complex situations, a team of knowledgeable personnel who are familiar with the work is usually necessary.

As an example, consider this simple risk matrix. Table 1 shows the relationship between probability and severity.

Severity ratings in this example represent:

High: major fracture, poisoning, significant loss of blood, serious head injury, or fatal disease

Medium: sprain, strain, localized burn, dermatitis, asthma, injury requiring days off work

Low: an injury that requires first aid only; short-term pain, irritation, or dizziness

Probability ratings in this example represent:

High: likely to be experienced once or twice a year by an individual

Medium: may be experienced once every five years by an individual

Low: may occur once during a working lifetime

The cells in Table 1 correspond to a risk level, as shown in Table 2.

These risk ratings correspond to recommended actions such as:

Immediately dangerous: stop the process and implement controls

High risk: investigate the process and implement controls immediately

Medium risk: keep the process going; however, a control plan must be developed and should be implemented as soon as possible

Low risk: keep the process going, but monitor regularly. A control plan should also be investigated

Very low risk: keep monitoring the process

Let’s use an example: When painting a room, a step stool must be used to reach higher areas. The individual will not be standing higher than 1 metre (3 feet) at any time. The assessment team reviewed the situation and agrees that working from a step stool at 1 m is likely to:

Cause a short-term injury such as a strain or sprain if the individual falls. A severe sprain may require days off work. This outcome is similar to a medium severity rating.

Occur once in a working lifetime as painting is an uncommon activity for this organization. This criterion is similar to a low probability rating.

When compared to the risk matrix chart (Table 1), these values correspond to a low risk.

The workplace decides to implement risk control measures, including the use of a stool with a large top that will allow the individual to maintain stability when standing on the stool. They also determined that while the floor surface is flat, they provided training to the individual on the importance of making sure the stool’s legs always rest on the flat surface. The training also included steps to avoid excess reaching while painting.

Validation of Risk Assessment tools in CF-CAMHS

Mental Health and Criminal Justice Practitioners are frequently required to predict and make decisions about how to manage different levels of risk posed by individuals, both to themselves and to others; recently this expectation has been extended to those working with children and young people.

Subsequently risk assessment tools have been developed that assess both risk and protective factors, and research is required to see how well these new tools support clinicians in making decisions about risk. In particular, when used with children and young people who have mental health issues, and use services in the community, which is a group that has the potential to be high risk because of lack of formal supervision, and has been neglected by previous research.

This research will use four risk assessment tools, that include protective factors which look specifically at those areas which make it less likely that a person will engage in risky behaviour, developed for use with children and young people. These assessment tools will be used with the current caseload of the 10 NHS funded Community Forensic Child and Adolescent Mental Health Teams in England. They will then be followed up over 6 and 12 months to measure their ability to predict violence, in addition to other high risk behaviours such as self harm, suicide and substance misuse.

It is anticipated that this research will make an important contribution to the knowledge about risk assessment in children and young people in contact with forensic community mental health services. It will also promote the development of a standard risk assessment schedule to improve the communication of information about risk, and to provide cohesion and consistency among disjointed services with a potentially high risk population.

Children and Young People-Mental Health Safety Assessment Tool (CYP-MH SAT) study: Protocol for the development and psychometric evaluation of an assessment tool to identify immediate risk of self-har

They may however have more motivation to take part than other populations and/or possess preconceived investments leading them to respond in a particular way.

An opportunistic sample of self-selected experts will be used to inform the construction of the suicide and self-harm risk assessment.

This protocol is tailored towards an English-speaking population, therefore, further national and international testing and adaptations may be required to achieve wider generalisability.

This study seeks to address the limitations of established assessment tools of immediate risk of suicide and self-harm in children and young people, in adherence to published psychometric evaluation guidelines.

To our knowledge, this is the first UK-based study to develop an assessment tool to ascertain immediate risk of suicide and self-harm in children and young people presenting to acute paediatric hospital settings in mental health crisis.

To establish the psychometric properties of CYP-MH SAT in CYP presenting in MH crisis to the ED and inpatient wards in acute paediatric hospital settings.

To identify, through expert consensus, the most pertinent items for inclusion in a CYP-Mental Health Safety Assessment Tool (CYP-MH SAT) to assess immediate risk of self-harm and suicide in CYP experiencing MH crisis.

The aim of this study is to develop and provide an initial psychometric evaluation of an evidence-based tool to assess the immediate safety of CYP (aged 10–19 years) in MH crisis presenting to acute paediatric inpatient hospital settings.

As such, across the UK, there is currently no standardised, specifically designed risk assessment tool being used within paediatric inpatient settings that assesses the immediate risk of self-harm or suicide for CYP experiencing MH crisis.

Evidence suggests that risk assessments are no more accurate at predicting risk than expert specialist MH professional clinical judgement in non-acute psychiatric outpatients. 16 However, acute paediatric care settings present specific differences in utility, focus and context that make the application of an assessment of suicide and self-harm unique. 7 For example, the assessment is usually made by non-MH experts who may lack specialist knowledge and experience to inform clinical decisions. Furthermore, assessments are focused on immediate risks of self-harm or suicide during receipt of acute paediatric care; not projected to weeks, months or years. Additionally, assessments are performed in time limited circumstances with CYP with potentially dynamic and fluctuating MH. Therefore, to enable implementation of a plan of care where immediate risks can be mitigated, healthcare professionals require appropriate support and guidance to inform their assessment. In current practice, risk assessments of CYP suicidal or self-harm behaviour in paediatric inpatient departments are typically undertaken through a variety of non-validated tools that are often created by the specific department, and then generally completed by non-MH clinicians. 17 However, some acute paediatric departments do use previously validated suicide risk assessment tools, but these tools have not been validated in populations presenting to acute paediatric care, very rarely assess immediate suicide risk and rarely include items on self-harm.

The assessment of CYP experiencing a MH crisis should involve: the identification of the main clinical and demographic features known to be associated with their MH crisis and identification of the key psychological characteristics associated with risk, in particular depression, hopelessness and continuing suicidal intent. 11 In addition, any immediate physical health needs (such as wound care, use of antidotes, gastric irrigation and psychotropic medication should be addressed) 12 ; and their safety should be maintained until expert assessment is undertaken by specialist MH professionals. However, in order to implement a plan of care where attempts can be made to mitigate immediate risks, health professionals (such as paediatricians and children’s nurses) need to be supported to make an informed assessment. Invariably this will have to be made in time limited circumstances and with CYP with potentially changing MH status. Therefore, the assessment should focus on identifying the most pertinent risks (ie, immediate risk of self-harm or suicide) and take into account risk factors, coping abilities and assessment of lethality of previous suicidal and self-harm behaviour. 13 14 Such factors can be useful to differentiate between high-risk and low-risk suicidal and self-harm behaviours. 15

Professionals who provide care for CYP experiencing MH crisis identify, it can be one of the most complex and stressful duties undertaken in practice. 10 This could be attributed to the acuity of the child’s status, as crisis is defined as a psychiatric emergency. However, health professionals’ responses could also be governed by the perception that poor experience and outcome of this acute phase of the CYP care pathway may negatively impact on their adherence with follow-up and future MH. In turn, there is accumulating evidence that non-adherence to follow-up is a predictor of poor outcomes, in terms of repeated self-harm and suicide but also in a variety of other psychosocial outcomes.

For CYP, initial triage and care is delivered by paediatricians and registered children’s nurses working in acute paediatric settings, 9 including EDs and paediatric inpatient wards. The main focus of this initial part of the CYP care pathway is to ensure that they are appropriately assessed to direct a plan of care and to ensure that they are safe until definitive and expert MH assessment is undertaken.

Nationally the care pathway for CYP in MH crisis varies considerably. The majority of acute and initial care is delivered by non-MH professionals in general healthcare settings, 7 such as paediatricians and registered children’s nurses. Whereas specialist mental healthcare is delivered by professionals (including psychiatrists, nurses, social workers and psychologist) with specialist training, skills and knowledge in working with CYP with MH difficulties. 8

Mental health (MH) crisis has been defined as ‘an acute disruption of psychological homeostasis in which one’s usual coping mechanisms fail and there is distress and functional impairment’. 1 This may include: extreme anxiety or panic attacks; psychotic episodes (including delusions, hallucinations, paranoia and/or hearing voices); hypomania or mania; other behaviours that feel out of control and acts of suicide or self-harm. 2 MH crisis is recognised as a psychiatric emergency as it is ‘an acute disturbance of thought, mood, behaviour or social relationship that requires immediate intervention’. 3 It is estimated to be the primary cause of around 5% of emergency department (ED) attendances 4 with the most prevalent presenting conditions being self-harm and/or suicidal behaviours. For these conditions alone, data for children and young people (CYP) aged 10–19 years in England indicates the prevalence of suicide is 4.3 per 100 000 5 and self-harm is 435.95 per 100 000. 6

Methods

This study incorporates three phases as outlined in figure 1:

Figure 1 Children and Young People (CYP)-Mental Health Safety Assessment Tool study flow chart. C-SSRS, Columbia suicide severity rating scale.

Phase 1: scoping review of existing evidence The possible domains for the development of a CYP-MH SAT to be used by non-expert MH professionals in an acute paediatric setting were identified from clinician feedback and themes identified from the investigation and root cause analysis of the high-level incidents at a local National Health Service (NHS) Trust. From this, the immediate risk of (1) self-harm and (2) suicidal behaviour were identified as the most important factors to be assessed by the tool. Subsequently, we conducted a scoping review of published literature to identify evidence-based items used to assess risk of self-harm and/or suicide in CYP in acute inpatient settings. From this review, 22 assessment tools were identified, of which 12 were accessible and retrieved.18–29 Importantly, none of 22 assessment tools identified in this scoping review were specifically developed for and tested on a population accessing paediatric inpatient care in MH crisis. Thus, all items from the 12 accessible assessment tools were collated and grouped into thematically similar subject headings using framework analysis.30 Following removal of duplicate items and collapsing of similar items, a total of 93 items were identified (themes, subthemes and items are outlined in online supplementary table 1). These items identified from the literature will now be used to inform the preliminary round of the Delphi survey, proposed to be undertaken in phase 2a. Supplementary file 1 [bmjopen-2017-020964-SP1.pdf]

Phase 2a: Delphi survey The purpose of this phase is to gain consensus of the relevance of items identified from the scoping review (phase 1) using the Delphi method. The Delphi method involves successive questioning with a panel of experts and key stakeholders to develop consensus regarding a particular issue.31 For this study, experts and key stakeholders will be requested to rank the items according to their perceived relevance. Expertise will be defined as having experience of delivering care to CYP in MH crisis or having expertise in CYP MH. In order to canvass the views of a range of experts and key stakeholders, no stipulation will be made as to how long they had been working in this field. However, information pertaining to the characteristics of participants was collected to explore and contextualise the results. To form the panel of experts and key stakeholders, we will aim to recruit a purposive sample of 20–30 professionals including: Psychiatrists, Paediatricians, Nurses, Clinical Support Workers, Academics, Public and Patient Involvement representatives. Participants will be recruited from three NHS Trusts and two non-NHS organisations (Higher Education Institution and Local council). We would like opinions from a range of differing staff types/grades and aim to recruit equal proportions of each staff type to prevent over-representation from one particular view point possibly shared by a group of individuals sharing the same characteristic (such as job type).32 Staff will be invited to take part by the site Local Collaborator via an email containing a participant information sheet, instructions for questionnaire completion and a link to a modified electronic Delphi survey (Bristol Online Survey: BOS software). Staff will be informed that completion of the survey indicates consent to take part. The survey will consist of two sections: (1) demographics: email address, job title, staff grade, employing organisation, gender, date of birth and ethnicity; and (2) the list of items generated from phase 1 (see online supplementary table 1). Participants will be asked to rate each item in relation to its relevance in assessing immediate risk of self-harm and/or suicide for CYP presenting in MH crisis to acute paediatric hospital settings. Relevance to the assessment of immediate risk of suicide and/or self-harm for CYP in MH crisis in acute paediatric inpatient settings will be reported on a 4-point Likert scale (1-not relevant, 2-somewhat relevant, 3-quite relevant, 4-highly relevant)33 using a closed questioning procedure. The survey also allows participants to type any items they think should be included using open-ended questioning. The survey will take no longer than 15 minutes to complete and participants have 2 weeks to complete it.34 Staff will receive an email reminder 1 week before the return due date. Newly identified items from open-ended questioning will be included in the second iteration of the questionnaire to decipher consensus on the new items. Items will be removed if they do not achieve the prespecified consensus margin (≥65%–70%; median ≥3.25).35 Only items within the prespecific consensus margin will be redistributed in successive Delphi survey rounds. The survey will be distributed in three rounds to achieve consensus.36

Phase 2b: nominal group technique The nominal group technique is widely used for problem identification, solution generation and decision-making37 and can be used in groups of varying sizes.38 In this phase, respondents from phase 2a will be invited to attend a 2-hour meeting and will be asked to provide their opinions regarding face validity of the CYP-MH SAT.39 Group facilitators (JCM, GMW and TC) will facilitate discussions regarding any required changes to the tool including item phrasing, attribution of suitable rating scales and question order. When disagreements occur, opinions with the highest consensus in the group will be prioritised. The CYP-MH SAT will be considered finalised for further psychometric testing once the changes subject to expert opinion have been implemented.

Phase 3: psychometric evaluative study The study is a multicentre, psychometric evaluation study.

Eligibility and recruitment CYP ‘cases’ and ‘non-cases’ will be recruited from acute paediatric hospital settings (EDs and wards) across three NHS trusts in the East Midlands, UK. CYP will be considered eligible for recruitment based on the criteria outlined in box 1. Box 1 Eligibility criteria for entry into phase 3 Inclusion criteria Aged 10–19 years.

Approved National Health Service Trust site.

Cases: Presenting to acute paediatric hospital setting in mental health crisis as defined as: having reached ‘breaking point’, likely to harm themselves or others and behaviours that feel out of control, including: extreme anxiety or panic attacks; psychotic episodes (including delusions, hallucinations, paranoia and/or hearing voices); hypomania or mania and acts of suicide or self-harm; those who have engaged in non-suicidal self-injury or low-lethality self-harm.

Non-cases: Presenting to acute paediatric setting not in mental health crisis but presenting with a primary physical medical illness or injury. This is defined as a health problem having physical origins, which can be short term (eg, accidental injury, influenza, migraine, infections) or long term (eg, diabetes, asthma, arthritis).

Mental capacity to consent.

Parental/legal guardian consent and child assent (under 16 years old).

Young person consent (over 16 years). Exclusion criteria Unable to speak or comprehend English language.

Currently receiving active end-of-life care or considered too medically ill by clinicians.

Non-cases: Current mental health crisis. Registered clinical staff will make the initial approach to participants. The informed consent process will then be performed by trained registered clinical staff or research team members.

Sample size and justification Based on needing 4–10 participants per questionnaire item in order to conduct the psychometric testing procedures,40 100–200 cases and 100–200 non-cases are required. We envisage the CYP-MH SAT that will be evaluated in phase 3 will not exceed 20 items.

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