At Monroe Carell Jr. Children’s Hospital at Vanderbilt, a systemwide behavioral health model led to measurable improvements in care, safety, and staff confidence.
Implementing new multidisciplinary workflows helped reduce behavioral health boarding admissions by 78% and shorten patients’ length of stay by more than 50%. And consultations by a recently hired board-certified behavioral analyst significantly improved patient care and reduced restraint utilization by 67%.
These outcomes are the result of a deliberate effort to develop and refine workflows, communication practices, and tools, and embed specialized expertise across inpatient units and the emergency department.
“What was happening before was the right hand never knew what the left was doing,” said Heather Kreth, PsyD, director of acute behavioral health. “It’s been a long journey, but we’ve taken a multidisciplinary approach to make sure we are doing as much as possible to provide individualized care for patients and improve safety.”
Real-time communication
Leaders and frontline staff from nursing, social work, child life, psychiatry, psychology, and hospital medicine have integrated twice-daily behavioral acuity huddles into their daily operations.
The 10-minute check-ins to review patients with elevated behavioral needs improve situational awareness, support proactive planning, and help teams anticipate challenges during shift changes or overnight hours.
“These behavioral acuity watcher huddles allow us to go through rooms in the hospital with patients that are boarding for behavioral health,” Kreth said. “It’s really a great place to discuss where we have concerns in the hospital.”
Additionally, a weekly multidisciplinary workplace violence event huddle provides a real-time review and response to patient safety events. The team uses a key driver diagram to address care opportunities and gaps, identify patterns, and assign immediate action items.
The meetings are structured, spending 5-8 minutes on each patient incident and identifying issues quickly — rather than waiting weeks for retrospective review.
Monroe Carell also launched a Behavioral Emergency Support Team (BEST) to provide immediate expert assistance focused on patient behavioral de-escalation. The team was piloted without adding new full-time positions and has relied on existing staff with expertise and interest in de-escalation.
Specialized expertise
One of the most impactful additions to advance these efforts has been the integration of a board-certified behavior analyst (BCBA) into the huddles and inpatient and emergency care.
The BCBA provides real-time consultation across units, helping teams adapt care, adjust routines, and implement individualized behavioral strategies.
“If you’re talking about behavioral interventions that can be targeted for severe problem behaviors, that really does benefit from someone with true expertise in behavior and intervention,” Kreth said. “Our BCBA is making a significant impact on the care of kids.”
Teams have also received targeted training from the BCBA on safe and compassionate care for neurodiverse patients. The education has influenced staff confidence and care delivery more broadly, helping teams safely perform complex medical treatments for kids who might otherwise struggle with care.
Behavioral health tools
Monroe Carell also utilizes several tools to alleviate any hesitations providers may have in caring for behavioral health patients. Five primary components help teams identify risk early and tailor care plans to patient-specific needs:
- Broset Violence Checklist (BVC): A short-term violence prediction instrument assessing confusion, irritability, boisterousness, verbal threats, and physical threats or attacks. Patients under 18 years old presenting with one of 20 serious behavioral health diagnoses are required to complete this assessment within four hours of admission.
- Admission orders: Standardized protocols allowing providers to individualize admission orders based on a patient’s specific needs. These are tailored to the primary concern, such as suicide risk, elopement risk, aggression or agitation, substance withdrawal, or medical adherence.
- My Health Passport: Allows mental health specialists and nurses to gather additional information directly from the patient or their guardian about patient-specific preferences, needs, and triggers. This is currently used as a quick-reference document at the bedside, but work is underway to integrate the tool into the electronic medical record and platforms where families can share information earlier.
- Stoplight safe activity list: A staff resource to individualize patient access to coping and comfort items. Supplies are organized by color, so staff can respond quickly during moments of escalation.
- Shared behavioral plan of care: Automatically displays to all clinicians accessing the patient’s electronic medical record. This is used only for high-acuity patients to reduce alert fatigue and improve effectiveness. Plan details inform staff of individualized, evidence‐based interventions to decrease agitation and episodes of aggression.
Sustained progress
A behavioral health task force made up of clinical and quality improvement leaders, a project manager, and executive sponsors oversees this work. The group meets regularly to discuss new and existing initiatives and ensure progress remains supported throughout the organization.
“If you’re trying to do things in isolation with kids across different teams and nobody is talking to each other, things are going to fall through the cracks,” Kreth said. “This group makes sure everyone has a voice in behavioral health care and we keep this work moving forward.”
This work was presented in the “Streamlining Mental Health Boarding via Data and Leadership” session at CHA’s 2025 Annual Leadership Conference.
