WORCESTER—Disruptive and even dangerous behavior has escalated at UMass Memorial Children’s Medical Center since 2021. In response, a pilot program known as PediBERT (Pediatric Behavioral Response Team) was created and had its launch during April school vacation.
Though it is early to assess, Nicole Brisbois, nurse manager of the pediatric emergency room, said feedback is positive. “I got an email today saying what a win [the pilot] is…no injuries,” she said.
The program was prompted by complaints from staff about being on the receiving end of physical threats, abusive and obscene language, violent assaults, and other risky behaviors, according to Brisbois. Some patients under the age of 18 have also been destroying UMass property, inflicting self-harm, threatening to flee, and exhibiting suicidal actions.
Staff was tasked with trying to de-escalate these situations without adequate training, often in areas not designed for mental health matters. In response, this resource cushions medical and other staff with the reassurance that help is available, and only an activation away.
Jemima Amankwah, nurse manager for emergency mental health, said it took two years to bring the project to fruition. The first year involved brainstorming, focus groups developing what the program would look like, and defining the necessary tools of support.
A response team was formed that is comprised of a team leader/physician, primary and resource nurses, an emergency mental health nurse and assistant, a child life specialist, and a consulting psychiatrist or psych liaison.
As needed, campus police may arrive on the scene for safety purposes.
Brisbois said the team will help kids wherever they are—whether it is the pediatric emergency department, triage, ICU, floor pediatrics unit or the specialized pediatric mental health area, which Brisbois said the hospital is fortunate to have.
However, the designated mental health area can “fit only five kids if they get along,” Brisbois said.
“Since COVID especially, children have been struggling with their mental health and feelings. It affected them and there are a lack of services in the community,” Brisbois said.
Amankwah agreed COVID is likely at the root of the surge of problems UMass is experiencing.
The number of kids needing support jumped from five to 10 to 20 children per week, she said.
As an example, Amankwah referenced children with autism who thrive on routine. COVID disrupted their schooling and life and it took its toll, she said.
“We really have to get creative with the care we give and treatment while they are here so that they can be successfully discharged,” Amankwah said.
She expects the program to be evaluated in two months to see what can be added or improved upon.
Since the response team’s implementation, there have been a couple of calls per week. They are still working out the kinks, according to Brisbois.
“It’s been eye-opening,” Amankwah said.
Both Brisbois and Amankwah expect the next step will be expanding to create a similar response team for adult patients, whose risk behaviors are also on the rise.
Brisbois noted PediBERT calls upon its existing personnel and has not resulted in any new hires.
She wants to assure the public that whether children are being seen for medical or mental health reasons, UMass has taken action to address problems “to the highest level” deploying the lowest degree of intervention possible.
“Safety is our priority,” she said. That includes for staff and patients but also other patients, family members and visitors.
For parents, Amankwah added, “Our goal is to ensure your child gets the best care in the most supportive environment…The right people are giving (your children) care even in their most deregulated states, regardless of what they are going through.”
Susan Gonsalves is currently editor-in-chief of a mental health trade journal and a freelance writer/editor specializing in education, medical/health and business. She previously worked at the University of Massachusetts Dartmouth and has contributed to publications at Worcester Polytechnic Institute and College of the Holy Cross. At the Worcester Telegram, she covered the town of Leicester and wrote for Business Matters. She can be reached at smgedit@comcast.net
