Risk mitigation for children and young people in mental health crisis admitted to acute paediatric care: a mixed methods exploratory study.

Abstract

This study aimed to identify and prioritise practical risk mitigation strategies that can be implemented by paediatric teams to improve the safety of children and young people (CYP) in mental health crises admitted to acute paediatric care. A sequential two-stage mixed-methods exploratory study. UK acute paediatric hospitals/wards. 16 Healthcare Professionals/CYP experts through experience. None. In <i>stage 1,</i> risk mitigation strategies were identified through a systematic review and qualitative interviews followed by thematic analysis. In <i>stage 2,</i> strategies were prioritised using a hybrid Nominal Group Technique and modified Delphi process and stratified according to clinical risk level (low, medium, high, very high) using a validated paediatric mental health risk assessment framework. 26 risk mitigation strategies were identified, of which 16 achieved expert consensus (≥70%) for clinical usefulness. Clinically actionable strategies included: structured safety checks on admission and daily thereafter; proactive environmental modification to reduce triggers (noise, crowding, ligature risks); active 1:1 observation focused on therapeutic engagement rather than surveillance; prioritisation of timely assessment and escalation to specialist mental health services and routine use of multidisciplinary safety huddles. Strategies were mapped to risk level, enabling paediatric teams to tailor interventions proportionately to assessed risk. This study provides an evidence-informed, consensus-based set of risk mitigation strategies that can be implemented immediately within acute paediatric care. By embedding structured safety checks, therapeutic engagement and risk-informed environmental controls into routine practice, non-mental health clinicians can enhance safety and consistency of care for CYP admitted in mental health crisis.