Like hospitals across the country, Children’s of Alabama saw demand rise sharply during and after the pandemic driven by a youth mental health crisis.
The hospital steadily expanded its behavioral health footprint, but the challenges of caring for these patients extended beyond designated behavioral health units.
“What we’re seeing is distress everywhere,” said Lisa Cooper, RN, director of the hospital’s nursing professional development. “Behavioral health patients may be housed in specific areas, but patients with physical conditions experience distress too. And in a post-pandemic environment, workplace violence is increasing across health care.”
Rather than relying solely on intensive, in-person crisis prevention training for select units, the organization adopted a layered strategy — educating staff early, broadly, and continually over time. The foundation of that approach at Children’s Alabama is Pediatric Learning Solutions’ (PLS) online courses.
“More staff are encountering challenging behaviors, even if behavioral health isn’t their primary focus. Nurses, clinical assistants, and other frontline staff need tools to recognize escalation early and respond appropriately,” Cooper said.
Cooper, who oversees education for more than 2,100 nursing employees, shared her approach to training staff in behavioral health and de-escalation in an increasingly escalated environment.
How did you decide to use PLS as part of your education strategy?
We see PLS as a strong first layer. The courses are asynchronous, evidence-based, and accessible at any time through our learning management system. That makes them ideal for onboarding and annual reinforcement. They allow us to introduce critical concepts early and ensure consistent baseline knowledge across roles.
Which staff members take PLS behavioral-health-related courses?
Within nursing services, both RNs and clinical assistants take them. Clinical assistants complete the courses “Crisis Prevention through Verbal and Nonverbal De-Escalation Strategies” and “Care of the Pediatric Patient with Suicidal Ideation.” RNs take those as well, plus “Caring for the Patient with Behavioral Challenges” and “Effective Use of Psychotropic Medications in the Prevention and Management of Disruptive Behaviors.” The suicide course has become a regulatory standard to make sure we are really screening for suicide across the nation.
How do these courses fit alongside in-person training like the Crisis Prevention Institute (CPI)?
CPI is an excellent, in-depth program, but it’s not appropriate or feasible for every role. The PLS courses provide foundational skills for staff who may not need CPI, who are waiting to attend it, or who took it but would benefit from reinforcement later on. In areas like perioperative services, the foundational knowledge PLS offers is often exactly what staff need.
How do you decide which courses to assign each year?
We’re very intentional. We use the Donabedian model — looking at what’s new, what’s changed, and what’s high-risk. We balance homegrown education with external content like PLS, and we’re careful not to overload staff with too many computer-based trainings. Beyond the behavioral health and de-escalation trainings from PLS, we use many other PLS courses like the age-specific courses covering care for newborns through adults.
Why keep de-escalation training in the annual curriculum, even for experienced staff?
Because repetition builds muscle memory. De-escalation isn’t something you want to think through for the first time in a tense moment. Revisiting those principles annually helps keep the skills fresh and reinforces consistent approaches across the organization.
What kind of feedback have you received from staff?
Most of it is informal but very telling. During our transition-into-practice program for new nurses, we ask what strategies they’re using from the PLS courses. They talk about positioning themselves near the door, keeping their voice low, maintaining eye contact, and keeping their hands visible. Those are techniques reinforced through the PLS courses and modeled by preceptors.
How do PLS courses support regulatory and competency requirements?
The built-in assessments are valuable. They provide documentation that staff completed the education and demonstrated understanding. Combining lectures, hands-on training, and online courses helps us show regulators that competencies are being addressed thoughtfully.
What would you say to other children’s hospitals considering PLS?
PLS works well as a foundation for all kinds of staff. It’s flexible, scalable, and relevant across roles. It doesn’t replace hands-on training for the roles that need it, but it strengthens those trainings by preparing staff ahead of time and reinforcing skills consistently. And it’s invaluable for staff who won’t receive intense CPI training. In today’s environment, almost everyone working in a hospital can benefit from online de-escalation and behavioral health training.
