Entrustable Professional Activities

LG12: Acute behavioural and psychiatric presentation and management

Learning Goal 12

Acute behavioural and psychiatric presentation and management

Manage paediatric patients presenting with behavioural and/or psychiatric disturbances in the emergency department

This activity requires the ability to:

  • identify possible causes of patients’ distress and behaviour
  • understand how neurodivergence may result in behavioural differences that require different assessment and management strategies
  • use techniques to de-escalate patients
  • assess patients’ mental states and level of risk for injury, suicide, or violence
  • formulate differential diagnoses and management plans
  • determine the need for medical intervention or admission
  • coordinate multidisciplinary care
  • communicate assessments and plans with patients, families, whānau, and/or carers, emergency mental health services, and admitting teams
  • document all interactions, discussions, assessments, and management decisions

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • take relevant histories and examinations for psychiatric or acute behavioural disturbance presentations, including mental state exams, assessments of cognition, and, if appropriate, developmental assessments
  • conduct appropriate risk assessments and psychosocial screenings, including assessment of suicide / self-harm risk, and risk to others
  • differentiate between acute behaviour psychiatric disturbances and psychiatric disorders or organic cause
  • assess for potential medical causes / contributions
  • determine the need for inpatient admission criteria due to safety concerns
  • initiate psychotropic medications if indicated
  • administer methods of sedation
  • manage complications of sedation if they arise, including resuscitation
  • develop appropriate discharge plans, including outpatient mental health referrals, safety planning, and psychoeducation for patients discharged home

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate understanding of the symptoms and examination findings that concur with the diagnosis of acute psychiatric presentations
  • demonstrate understanding of the symptoms and examination findings that suggest the diagnosis of an organic cause for behavioural disturbances

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • communicate in a style that allows pertinent psychiatric histories to be obtained
  • use a communication style that allows young people to be asked sensitive questions about the cause of their distress without distressing them further, when required
  • maintain a non-judgemental attitude towards the behaviour of children or adolescents
  • use crisis intervention and de-escalation techniques
  • check with, and, where appropriate, involve family, whānau, and/or carers in using calming or de-escalation techniques
  • provide documentation, including relevant histories, evaluations, risk assessments, and disposition plans

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate proficiency in adolescent interview techniques
  • demonstrate communication skills to sufficiently support the function of multidisciplinary teams

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • assess patients in a space where distractions are minimised
  • remove other patients and bystanders from the immediate vicinity, acknowledging that family and significant others may have an important role in assessment of patients
  • consider risks in the context of the emergency department setting, such as absconding or environmental hazards
  • evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
  • identify and manage key risks for patients during transitions of care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • evaluate quality and safety processes implemented within the workplace, and identify gaps in their structure
  • keep patients’ information secure, adhering to relevant legislation regarding personal information and privacy

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • participate in debriefing sessions following sedation of patients
  • obtain informed consent before involving patients in teaching activities

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • set goals and objectives for self-learning

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • critically analyse relevant literature and refer to evidence-based guidelines
  • participate in clinical research, and follow research protocols where appropriate

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • refer to guidelines and medical literature to assist in clinical assessments when required
  • demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use interpreters where required
  • liaise with Aboriginal and Torres Strait or Māori liaison officers or Indigenous mental health workers
  • engage with patients, families, whānau, and/or carers to gather information in an atmosphere of trust and cooperation
  • acknowledge and reflect on patients’ beliefs and values, and how these might impact on health

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • display respect for patients’ cultures, and attentiveness to social determinants of health
  • appropriately access interpretive or culturally focused services

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • assess patients’ capacity for decision making, involving a proxy decision maker appropriately
  • obtain consent from patients, families, whānau, and/or carers prior to the administration of any treatments or any restrictive practice

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • consider patients’ decision-making capacity
  • identify patients’ preferences regarding management and the role of families, whānau, and/or carers in decision making

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise the need for escalations of care, and escalate to appropriate staff or service
  • integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and causes into clinical decision making
  • assess the impact of developmental conditions and neurodiversity on behaviour

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • involve additional staff to assist in a timely fashion when required
  • recognise situations in which to ask for help

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • consult with psychiatry and/or social work staff as needed
  • coordinate multidisciplinary care for potentially high-risk presentations
  • provide support to the emergency department team, including junior clinicians and nursing staff, when managing acutely behaviourally disturbed patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • collaborate with other team members, based on their roles and skills
  • deliver appropriate multidisciplinary assessment and management

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • follow legislation, such as guardianship requirements and mental health acts, relevant to the local area, to assess if patients can legally be held in the hospital against their will or can be restrained, such as with the use of safe rooms or physical or chemical restriction
  • complete the appropriate state-based documentation when enacting forms of restriction, and follow local health protocols, guidelines, and policy

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • identify and navigate components of the healthcare system relevant to patient care
  • identify and access relevant community resources to support patient care