2023 14th Annual NUBE Conference

Intro: Both psychiatric and medical emergency providers may interact with law enforcement personnel (LEP) when treating pediatric patients for a variety of reasons, including caring for patients who are in custody, on involuntary psychiatric holds, or involved in cases of suspected abuse or neglect. The relationship between LEP and the medical team is important to maintain but is secondary to the relationship between the medical team and patient. This distinction is particularly important to consider when caring for youth, who lack legal--and frequently developmental--agency to advocate for themselves. The role of advocate is often taken up by the medical team, who must then navigate what is often a gray area for individuals who feel a need to protect their patient but have varying degrees of understanding of the law and varying degrees of comfort with interacting with LEP. Methods: A multidisciplinary team, Pediatrics-Law Enforcement Alliance for Youth (PLAY), was developed to review and create evidence-based, patient-centered, ethically sound hospital policies and procedures for patients whose medical encounter involves law enforcement. The team is comprised of physicians and APPs from various specialties, social work, security, hospital leadership, risk management and legal, on-campus law enforcement, and more. PLAY is tasked with evaluating and implementing organizational improvements in the process and care of patients with LEP involvement at Children’s Wisconsin (CW) in Milwaukee, WI, focusing primarily on Emergency Department and Hospital care. Results: Five areas of improvement have been identified: resource development, policy, education, scholarship, and engagement. The first resources developed have been focused on event reporting and incident review. The hospital policy has been revised and expanded to include language specific to involuntary psychiatric holds, the rights of both patients and guardians when a youth is in custody, and best practices regarding any kind of investigation by LEP related to patients and families. There has been considerable education and outreach both internally and externally regarding LEP and PLAY's overall mission. Finally, we have begun collecting current state data on perceptions and experiences with LEP as well as patient data for individuals who interact with LEP during their care encounters. Discussion: In pediatric emergency psychiatric care, interactions with LEP are inevitable. PLAY has made considerable progress towards ensuring our hospital policies and practices support patients' rights and promoting effective collaboration between CW healthcare workers and local LEP. While some interventions are specific to our hospital system and community, by approaching our challenges with an intent of patient-centered collaboration, we feel the spirit of our work can provide other systems with a framework for improving their own understanding of and interactions with LEP in the care of this vulnerable patient population.

Learning Objectives:

1. Understand the relationship between the medical team and law enforcement personnel (LEP) and how it relates to the relationship between the medical team and the pediatric patient.
2. Explore the development of a multidisciplinary approach to improving care for patients with LEP interaction.
3. Review initial outcomes of the work of this multidisciplinary team, including preliminary data on patient tracking and staff experiences.