Each year, nearly half a million children and adolescents are seen in emergency departments across the country for behavioral or mental health concerns. Many of them endure long “boarding” stays — waiting in general inpatient units for a psychiatric placement. These stays can be marked by a lack of personalized care, leaving young patients feeling overlooked and misunderstood.
Recognizing this gap, a team at Monroe Carell Jr. Children’s Hospital at Vanderbilt implemented My Health Passport — an individualized care planning tool designed to give children more power to participate in deciding how they could best receive care and be supported when in the hospital for behavioral health needs.
The hospital’s multidisciplinary Pediatric Behavioral Health and Intervention Team began using the tool in 2017 and recently decided to study its effectiveness. Led by Andrea Hughie, MSN, RN, Jessika Boles, PhD, CCLS, and Patti Runyan, DNP, MBA, RN, the researchers carried out a prospective cohort study to evaluate and understand patient, caregiver and staff perceptions of implementing the planning tool to support boarding stays in the hospital.
The study, “Individualizing pediatric boarding care: child perspectives,” enrolled 100 pediatric patients ages 8-17; 74 parents/caregivers; and 76 staff (doctors, nurses, staff) to gauge their satisfaction with the My Health Passporttool and understand ways to improve its use. The results, reported in the journal BMC Pediatrics, were overwhelmingly positive. The average satisfaction score was 7.72 out of 10, and participants said that the tool contributed to better outcomes and experiences.
Patients said the tool, a one-page, double-sided questionnaire, helped them feel more comfortable with staff and gave them a way to express their fears, preferences and coping strategies.
“They felt like the tool allowed them to express themselves, allowed them to actually tell caregivers who they were and what they needed out of their care experience,” said Boles, an assistant professor and Certified Child Life Specialist.
Parents and caregivers appreciated the tool too, as it gave them a chance to share insights into their child’s needs. Staff found it useful as well, especially when it was integrated into workflows and made easily accessible.
So how is the MHP tool used? Patients and their caregivers are presented with the My Health Passport tool at the hospital and encouraged to fill it out. Questions explore, in part, how the patient best communicates needs (verbally, using hands/sign language, communication boards); what makes the child upset or calm down; how they respond when triggered; medical procedures that are difficult to handle; favorite things; food likes or dislikes; and an open-ended additional information section. The sheet is then hung by the patient’s bed, and it is also scanned into the electronic health records so hospital care teams can see the responses throughout the boarding stay.
Study researchers also looked at the questions asked in the passport’s survey.
“Our study surveys looked at different things like people’s feedback on the content of the form,” said Boles. “So, were we asking the right questions within My Health Passport? Were those the things that children and families thought were important to know about the child? Did we approach you at the right time? Did we explain the form enough to you? Did we do this in a sensitive and thoughtful way?”
What’s next? Hughie said the team wants to continue working to implement recommendations from patients, caregivers and staff. Patients want the MHP tool introduced earlier in their hospital encounter, and they would also like it to follow them beyond their inpatient stay to ambulatory clinic visits.
“I think this validated that kids really just want a vehicle to be heard,” Hughie said.
“And if we do a good job listening and responding to what kids are telling us, we’re not just improving their hospital stay — we’re influencing how they interact with the health care system for the rest of their lives.”
Other study authors and team members include Dorinda Brown, MSEd, Delana Vallery, MA, Emily Irwin and Briana Keller.
