Setting a new standard: Developing and operationalizing a trauma-informed delivery of care model

---

Danielle L Millike and Lisa R Schneider

CHOC Children’s Hospital, USA

: J Health Inform Manag

Abstract

---

Mental illness is a growing concern among families and communities worldwide. In the United States alone, one in five children, aged 13 to 18, suffer from a severe mental illness (National Alliance on Mental Illness, 2018). Unfortunately, onefourth of those families find it problematic locating and initiating services for their child as waitlists for mental health treatment can exceed three months. Even more troubling is the fact that 80% of children with mental illness do not receive any treatment at all (American Academy of Child and Adolescent Psychiatry, 2013). Based on these staggering statistics there is clearly a dire need to increase access to pediatric mental health services. In an effort to address this crisis, CHOC Children’s Hospital in Orange County, California recently opened their Mental Health Inpatient Center (MHIC). The 18-bed center provides quality inpatient care to children ages 3 to 17. CHOC Children’s innovative and trauma-informed approach to treatment undoubtedly raises standards for the provision of inpatient mental health care. Many months of thoughtful consideration occurred to develop this elite and cutting-edge model of care. Founded with trauma-informed principals, the three areas of focus have been the center’s physical environment, patient care, and employee development. The MHIC was built with state-of-theart materials to promote the safety of both patients and staff. The 3,600 square foot child-friendly outdoor play area encourages all patients, regardless of their diagnosis, to spend time in the fresh air surrounded by beautiful scenery. In addition, the center offers a full seven-day programming schedule which consists of psychoeducational groups, study sessions, formal group therapy as well as both music and art therapies. This therapeutic group programming is facilitated by the interdisciplinary treatment team consisting of psychiatrists, nurses, mental health assistants, child life specialists, social workers, art and music therapists, and a full-time teacher and psychologist. In alignment with patient- and family-centered care values, CHOC Children’s encourages family involvement throughout the patient’s admission. Parents, grandparents and legal guardians are invited to remain on the unit 24 hours per day, seven days per week to promote transparency and treatment participation. Understanding the importance of comprehensive staff training and development is critical when opening a new unit. CHOC Children’s provided unique 9-week orientation training for all staff that included didactic and hands-on experiences, founded in trauma-informed care philosophies. The development and operationalization of this innovative care model has resulted in numerous positive outcomes including low restraint rates. The MHIC has had over 400 admissions thus far and has only utilized four-point mechanical restraints for three patients. In addition, zero patient or employee injuries have occurred. Furthermore, the MHIC scored 5.9 out of 6.0 for nursing staff engagement, which is well above the 90th percentile throughout the nation. Specifically, 100% of registered nurses ranked as fully engaged. Finally, the center has only had a 3% nursing turnover rate whereas the national data has shown mental health turnover rates of up to 45%.

Biography

---

E-mail: dmilliken@choc.org