In the midst of workforce challenges and a behavioral and mental health crisis, children's hospitals and health systems are searching for solutions. Organizations are tasked with caring for a changing patient population, supporting their employees and expanding access to care that requires new insight and new solutions.
Children's Healthcare of Atlanta set out to build a behavioral and mental health "ecosystem" that improves outcomes, reduces stigma and increases access to care. One of the first steps required developing workforce solutions to meet the organization's needs.
How to address the challenge
To build up its workforce capacity, Children's Healthcare of Atlanta first developed a multi-pronged approach focused on innovating care, transforming access and pioneering prevention. "We're examining how we can improve the quality of care for kids who are presenting to the hospital system in a state of crisis," says Lisa Schneider, M.S., B.S.N., RN, PMH-BC, NEA-BC, nursing behavioral and mental health director, Children's Healthcare of Atlanta. "Regardless of us not having an inpatient psychiatric unit, patients and their caregivers are still coming because they trust us and the care we provide."
For the organization to innovate behavioral and mental health care from a "whole child" perspective—looking beyond physical presentations and clinical care to improve health in every aspect of a patient's life—the hospital must train and adapt their workforce to meet these needs.
Alongside the workforce development efforts, staff and providers created a comprehensive program for behavioral health care within their system. This included implementing code BERT, a response designed to support patients and staff during escalating situations. In addition, they built out system-wide education focused on whole child care, including expanding upon the Strong4Life program, a resource platform for families.
Finding workforce solutions
Leaders at Children's Healthcare of Atlanta recognized that incorporating whole-child care into the hospital system required developing and implementing a behavioral and mental health (BMH) nursing team within the hospital. "We can teach anyone the basics of pediatric mental health, such as medications and diagnoses, but what we can't teach is compassion," says Schneider. "The biggest requirement to become a member of this team is to have a good heart that cares about this patient population and someone who seeks to advocate for them."
The project was broken down into three categories:
- Recruiting and training. The team consists of registered nurses and technicians that were both internal and external applicants. No prior psychiatric experience was required. The BMH team then underwent comprehensive training including Adverse Childhood Experiences (ACEs), trauma-informed care, suicide prevention, psychotropic medications, restraint competency, how to care for LGBTQ+ patients and more.
- Defining roles and responsibilities. The BMH nursing team is responsible for whole child care by decreasing stigma and promoting integration of trauma-informed principles into clinical practice. This team also provides education for frontline clinical staff to increase competency and confidence in caring for children with behavioral and mental health needs. The nurses are subject matter experts, code BERT leaders, and regulatory and compliance monitors. The technicians act as coping plan experts, patient safety sitter collaborators and patient care supporters.
- Increasing awareness and educating employees across the system. Current employees go through a yearly course dedicated to behavioral health resources throughout the organization, as well as basics in suicide prevention and restraints. Whole child care content was recently added. Current employees and providers can also attend the town halls and grand rounds, which take a closer look at pressing topics. These opportunities, combined with the behavioral and mental health team acting as role models for the entire organization, has allowed hospital staff to increase their awareness and skillset.
Meeting the teams' goals
Since this effort was launched, the team has made a substantial impact on behavioral health care within their community. And while there is still more work to be done, the BMH nursing team has cared for over 10,000 patients since December 2020 and 13,000 individualized coping plans have been created and implemented since the second quarter of 2020.
Additionally, in the Emergency Department, restraint utilization fell by 50% from 2020 to date, even as the organization experienced an increase in behavioral health volumes and acuity. Despite an increase in events of workplace violence, Children's Healthcare of Atlanta has also seen a 33% decrease in patient-related physical events since 2020.