It is vitally important to ensure patients not bring weapons or other dangerous objects into the ED Procedures to achieve this end may include use of metal detectors or a physical search of the patient and their belongings Some EDs use a protocol whereby all patients must wear a hospital gown and slippers while in the ED This separates the patient from their belongings and can facilitate a search for harmful objects Such a policy may also theoretically reduce the risk of patient elopement A safe and adequate physical space is an absolute requirement of the ED Patients with high risk of harm to self/others need to be under constant supervision by either ED medical or security staff via direct visualization of the patient or by continuous video monitoring At a minimum, the patient room should be free of objects that could cause harm including objects used for strangulation (e.g., medical tubing, electrical or equipment cords) Such objects should be either inaccessible to the patient (e.g., in locked cabinets) or physically removed from the room The optimal setting for a psychiatric evaluation is a quiet and lowstimulus environment in which interruptions are infrequent, and privacy and confidentiality are assured; ideally this environment would be a separate, distinct area from the main ED with direct access to medical and security staff and capacity for using restraints Clinicians in the ED should have a pre-existing relationship with a mental health team that is committed to providing child psychiatric consultation at all times The ED should also have relationships with (a) psychiatric inpatient unit(s), for efficient transfers and hospitalizations when needed The staff should be thoroughly familiar with the procedures for psychiatric hospitalization, including the specific legal requirements for involuntary commitment The hospital should have specific guidelines or protocols for the management of psychiatric patients requiring admission for treatment of medical conditions Finally, the ED should have relationships with other social agencies and an awareness of relevant laws The police should be aware of which children to bring to the ED for psychiatric assessment and should be prepared to remain in the ED until adequate security has been arranged Relationships should be developed with community mental health resources, temporary shelters, and other crisis intervention centers, ensuring effective referrals