Social workers Hailey Richardson (left) and Hunter Kameka (right) are seen in the Children's Hospital emergency department.
March 5, 2025
Hailey Richardson and Hunter Kameka are familiar faces in the paediatric emergency department at London Health Sciences Centre’s (LHSC) Children’s Hospital.
Social workers by training, Richardson and Kameka are part of a specialized team of staff providing 24/7 wraparound care to young patients arriving in the emergency department (ED) with mental health concerns.
“Mental health crises don’t take a break,” says Richardson. “That’s why we’re stationed in the emergency department 24 hours a day, seven days a week, 365 days a year, offering support and de-escalation to young patients in distress.”
From anxiety and depression to autism, ADHD and psychosis, there are a number of mood and behavioural disorders that can come to a head, severely impacting a child’s ability to function. During these times, many kids and their families seek support in the ED; however, its fast-paced nature means it's not always the ideal place to care for these types of patients.
“Mental health crises have the most successful outcomes when treated by mental health-trained practitioners who have time to sit with patients in a quiet space for an extended period of time,” says Jessica Blake, manager of child and adolescent mental health at LHSC. “While ED physicians play an important role in mental health care, their primary focus is on treating physical symptoms and traumas, whereas social workers can provide an added layer of emotional support. This ultimately means patients are receiving more specialized care while physicians have more time to tend to other cases.”
Social workers are uniquely positioned to care for patients experiencing a mental health crisis because they have a master's level education that gives them enhanced training in crisis intervention and trauma-informed care, adds Blake.
A patient-centered approach
When a patient experiencing a mental health crisis arrives at the emergency department, they are triaged by an ED nurse and then taken to a quiet space where they are met by a mental health nurse, child and youth counselor and social worker like Richardson or Kameka.
The social worker will sit with them to complete a robust assessment where the patient has the opportunity to tell their story in a safe and private setting.
“We take a biopsychosocial approach, which means we consider the different biological, psychological and social factors that can affect a child’s health and well-being,” explains Kameka.
During the assessment, patients are typically asked about school, their home environment, mental health history, any medications they take or substances they’ve experimented with, past traumas, the support systems they may have in place and their potential for self-harm.
If consent is given, the social worker will also complete an assessment with the child’s parent or guardian before discussing their observations with an emergency physician. The physician will then also have a discussion with the patient and family before deciding if the patient is safe to be discharged with resources and/or referrals or if they need to be admitted to hospital. Sometimes, a paediatric psychiatrist will also be consulted.
If a patient is considered well enough to go home, a child and youth counselor will meet with them before they leave to do safety planning and go over some helpful coping skills. This helps set them up for success from the moment they walk out the door.
'Not just about handing them a pamphlet anymore’
“We’re absolutely thrilled with the support our social workers and the rest of the paediatric mental health emergency team have been providing to patients during their most vulnerable moments,” says Blake.
Social workers were brought into the emergency department on a permanent, 24/7 basis just over a year ago when an increase in the number of young patients presenting with mental health concerns was observed and staff wondered how they could better serve these patients right from their very first interaction together.
Since then, repeat visits to the emergency department are down, as are hospitalizations and the number of patients who leave without being seen by a physician. This indicates patients are being assessed quicker and having their needs met.
“It’s not just about handing them a pamphlet anymore,” explains Richardson. “Now our team can actually take the time to listen to each patient’s story, talk them through what they’re feeling and teach them some strategies for coping going forward."
Unsurprisingly, many young patients and families who have met with Richardson and Kameka have indicated they finally feel heard. Children’s Hospital emergency physicians, too, have expressed their thanks to the duo and the other social workers on the team for helping to lighten the load and improving quality of care.
“We’re proud to play such a special role on one of the only dedicated paediatric mental health emergency teams in the province,” says Kameka. “We want kids to know that no matter what they’re going through, we’re here to help them.”