Mental Health Simulation Programme

Abstract

Background:

Mental health conditions are becoming increasingly prevalent in paediatrics and children with mental health crises frequently present to paediatric acute medical settings. Paediatric trainees often don't feel specifically equipped or trained to deal with acute crises and de-escalation of challenging behaviour.

Methods:

I have therefore developed a simulated patient scenario involving a paediatric patient presenting with a mental health crisis for use as a training tool. The scenario was written as part of my PGCert using current design templates from simulation literature and after exploring different simulation theory techniques and taking advice and inspiration from other simulation courses such as the Maudsley simulation courses. An abbreviated version of the scenario has been adapted for use as an in-situ simulation in the paediatric ED department at the Evelina London Children's Hospital.

Results:

The simulation was run in the paediatric ED department on 9/2/22 using a Maudsley trained actress. The paediatric team in ED were the main participants plus another group of paediatric trainees watched the scenario live on video link. Each group had separate debriefs. We also involved the security team and had very useful conversations with the team there about managing these patients in ED. There was very positive feedback and a lot of departmental learning. A newsletter detailing the learning points including highlighting relevant guidelines was circulated amongst the paediatric teams. A pre and post course survey was done to gather feedback from those who participated and to evaluate the usefulness of the course.

Analysis:

The post-course survey gave helpful feedback such as for example participants said the most valuable aspects of the simulation were “Useful to discuss policies for de-escalation,” “direct feedback from actor”  and “the team-work. Also the information from the security team was very interesting”. There was clear improvement from the pre to post course survey to show that there was increasing levels of confidence in verbally de-escalating a child in an acute mental crisis (5.5-> 6.5/10 average score) and increasing confidence with raising concerns regarding a child in acute mental distress (60%->100% with satisfactory level confidence and above).