Discussion response to Antoria

In Maricopa County, Arizona, several resources are available to support children and adolescents experiencing psychiatric emergencies. Individuals can contact the 988 Suicide and Crisis Lifeline or the Maricopa County Crisis Line (1-800-631-1314), which provides 24-hour crisis counseling and can dispatch mobile crisis response teams. These teams are composed of behavioral health professionals who evaluate safety concerns, assist with de-escalation, and determine whether the child requires emergency department evaluation or referral to crisis stabilization services. Hospitals and behavioral health centers such as Valleywise Behavioral Health Center also provide emergency psychiatric assessments and short-term stabilization for youth experiencing severe mental health symptoms (Arizona Health Care Cost Containment System [AHCCCS], 2024). In Arizona, involuntary psychiatric commitment is governed by Arizona Revised Statutes Title 36. When a minor is believed to pose a danger to themselves or others due to a mental disorder and is unwilling or unable to participate in voluntary care, a responsible party, clinician, or law enforcement officer may request emergency admission for evaluation. The child may be transported to an approved evaluation facility where a psychiatric assessment is conducted. The evaluation period generally lasts up to 72 hours, after which the court determines whether additional treatment or court-ordered care is necessary (Arizona Revised Statutes 36-524, 2024). When a child experiences escalating agitation during a psychotic episode, antipsychotic medications are commonly used to address psychosis and severe behavioral dysregulation. Both first-generation and second-generation antipsychotics may be used depending on the clinical situation. In some cases, benzodiazepines may also be administered to rapidly reduce agitation and improve safety in emergency settings (Saidinejad et al., 2024). Question: What non-pharmacologic strategies have you found most effective when attempting to de-escalate a pediatric psychiatric crisis before medications are required? References Arizona Health Care Cost Containment System. (2024). Arizona crisis services system. Arizona Revised Statutes 36-524. (2024). Application for emergency admission for evaluation. Saidinejad, M., Foster, A. A., Santillanes, G., Li, J., Wallin, D., Barata, I. A., Joseph, M., Rose, E., Cheng, T., Waseem, M., Berg, K., Hooley, G., Ruttan, T., Shahid, S., Lam, S. H. F., Amanullah, S., Lin, S., Heniff, M. S., Brown, K., Gausche-Hill, M., … ACEP Pediatric Emergency Medicine Committee. (2024). Strategies for optimal management of pediatric acute agitation in emergency settings. Journal of the American College of Emergency Physicians Open, 5(4), e13255.