The Psychiatry and Behavioral Medicine Unit (PBMU) at Seattle Children’s has recently implemented a new model of care that provides a better clinician experience for staff and an environment that is positive, preventative and predictable for patients and families. The PBMU sees children in psychiatric crisis ages 4 to 17 who have to stay overnight in the hospital for treatment. This change has been years in the making, with a significant amount of work beginning in October 2022.

The old model housed all patients together and allowed any clinician to work with any patient. The new model divides the PBMU into three programs based on the child’s age and behavioral needs (child inpatient, adolescent inpatient, biobehavioral inpatient) creating smaller and more distinct care teams rather than grouping all ages and diagnostic presentations together. Smaller teams encourage better communication, better hand-offs and improved continuity of care.

In addition to the team restructure, the PBMU adopted an overarching model of care called Modified Positive Behavior Interventions and Supports (M-PBIS) that is grounded on the assumption that behavior is learned, teachable, changeable, affected by the environment and is more likely to happen again when it is reinforced​. Used successfully on the inpatient unit at John Hopkins, the framework emphasizes positive and preventative strategies, offers multi-tiered system of support, emphasizes use of data tracking and measurable outcomes. Data monitoring is ongoing, and the team is specifically monitoring staff retention, patient restraints, and patient and staff injuries, in addition to disparities in restraint use.

Many people contributed to this effort including Director of the PBMU Maureen O’Brien, MHA, BSN, RN-BC; Clinical Director Alysha Thompson, PhD (project lead), Medical Director Ravi Ramasamy, MD, Acute Mental Health Services Medical Director Shannon Simmons, MD, MPH, Psychologists Eric Boelter, PhD, BCBA, Connor Gallik, PhD, and Sheena Friesen, PhD (current post-doctoral fellow and future faculty member); Psychiatrists Sina Shah-Hosseini, MD, and Nicholas Meinhardt, MD; the PBMU leadership team, and nurse and pediatric mental health specialist ‘super users’ who helped operationalize the new model.