Emergency Psychiatric Specialty Team at Children's National Medical Center

Emergency Child Psychiatric Specialty Team

Emergency Psychiatric Specialty Team at Children's National Medical Center

Emergency Department
Children's National Medical Center
Washington, District Of Columbia
United States
RN Lead: Theresa Wavra, MSN, RN Child Psych Specialists: Joshua Baggett, BS; Carolyn Washington, BS; Eliza Staley, BS; Renee Rosser, BS; Tijuana Thomas, BS; Adil Saleem, BS; Doug Wilson, BS; Sanica Bendre, BS; Vidya John, BS; Ray Rodgers, BS; Jasmin Shivers, BS; Brian Butler, BS; Physicians: Laura Sigman, MD; Angela Maxwell, MD; Nichole McCollum, MD; Eric Rosenthal, MD; Amie Cahill, MD; Shireen Atabaki, MD; Jaclyn Kline, MD; Psychiatric MD: Jorge Srabstein, MD RNs: Renee Clark, BSN, MPH, RN; Luwam Sehaye, BSN, RN; Brenee Young, MA, BSN, RN; Pamela Carlson, RN, CPEN, CPN; Trevor Kapralos, RN, BSN, CPN; Danielle King, BSN, RN; Kathryn Stadlin, BSN, CPEN; Marcus Tipton, BSN, RN; Ashley Warren, BSN, RN; Nurse Practitioner: Susan Smith, PMHNP-BC ED Tech: Carolyn Woods Psych SW: Temeka Parker; Brandi Smith; Katherine Rettke; Veturah Thomas; Social Work: Heidi Colbert Leadership: Theresa Schultz, MSN, RN, NE-BC; Tina Humbel, DNP, MHA, RN-BC, CPN, CCRN; Anthony Thomas, MSW, BSN, RN; Security: Cpl. Ha'Zel Jacobs; Officer Turkesa Ramirez; Officer Carlos McDonald

Our national health care system is working hard to meet the needs of children with mental health illnesses, however, it is proving to be a challenge. Children suffering from mental health illnesses have increased needs for subspecialty and there is a great demand for child mental health specialists. According to the American Academy of Pediatrics, a DC-based coalition has been developed to aid in advocating for these patients, but it requires an individual with intrinsic compassion and grit to challenge the health system to raise the bar and be an advocate at any level. We have exactly that type of person and her name is Theresa Wavra, RN!

Through Theresa’s steadfast leadership, commitment to the organization and compassion to care for pediatric patients with psychiatric emergencies and/or emergency behavioral management needs, she developed a resilient structure to support the community as well as a global need. Ultimately, she laid the foundation for our mental health program in the Emergency Department. With the resilient structure, Theresa was able to establish a team of Child Psych Specialists (CPS) and strengthened a partnership with our inpatient psychiatric unit by bridging the gap in communication to facilitate and streamline a plan of care. As a team, they provide extraordinary care to this vulnerable patient population through expert skill that demonstrates care, compassion, and commitment.

Theresa is dedicated to this population and recognized a need to increase awareness, to establish a standardized and evidence-based process to de-escalate patients while keeping our staff safe. Due to the increased volume of children needing emergency psychiatric care, having Theresa as our Psych Program Coordinator, the foundation of nursing care is the essence of the compassionate connection this vulnerable patient population requires.

It is because of the tireless efforts of Theresa Wavra RN, more than 2,400 patients have benefited from the establishment of our CPS team. Specifically, on Christmas Eve, the team was able to display the type of compassionate care of which we can all be proud. Although Theresa was out on maternity leave, her CPS team delivered the high-quality compassionate care through her leadership.

A patient arrived at our ED- Sheikh Zayed campus for psychiatric evaluation on Christmas Eve. The patient was a 12-year-old nonverbal boy with autism, who was in foster care with a history of being placed among multiple families who were unable to support his special needs. It was reported that he would often find himself in a foster home from as little as a few hours to sometimes a few days. The inability to find a stable home and loving environment was out of his reach.

Just prior to shift change, the patient was brought back to our ED for the second time in a 24-hour period. His newest foster family realized the placement was more difficult than expected and they were unprepared to care for a child with such complex needs. The CPSs identified our patient was in a vulnerable state and immediately took action to make him feel safe.

Our team of CPSs settled him in for the second time that day. The CPS team that evening immediately recognized the challenge of trying to establish a patient/provider relationship due to the patient's inability to communicate. Our patient displayed emotions such as fear, anger, uncertainty, and mistrust due to past experiences. Unfortunately, his emotions began to escalate and he began to display unsafe behavior. The intrinsic compassionate nature of the CPS team recognized they needed to act and act fast to de-escalate our patient as quickly as they could. Together they began interacting with him by playing catch in an attempt to re-direct his escalating behavior. As with any child, he became bored with the simple game and his behavior started to amplify. Our CP Specialists recognized the importance of decreasing stimuli in our patient's environment by turning out the lights and playing instrumental music on a phone.  As simple as this sounds, it is not an easy task in a fast-paced and stimulating environment such as the ED; but the CPSs went the extra mile to help create a soothing environment to de-escalate and re-focus our patient. At some point during the night, our patient soon began to show heightened behavior once again. In an attempt to make a connection with him, one CPS noticed our patient exhibited signs that he understood basic words in sign language. The CPS signed the word for “food” and our patient immediately showed signs of cooperation. Something as simple as asking if he wanted food translated into a situation that allowed him to become cooperative enough to continue with basic care. The CP Specialists were able to change him into a gown to allow for our medical team to provide the proper and much needed medical care.

The compassion and commitment of our CPSs did not stop there. While the patient was eating, our CPS staff made him a communication board. The newly made board was held in front of him and he was able to communicate by pointing to words such as “bathroom” and “food” to facilitate the staff ability to meet his basic needs.

As it was getting late into the night, the staff were anxious to make preparations to provide a magical night that we know as Christmas Eve.  It was important to get our patient to bed, but the CPS staff knew this could potentially be a challenge in a new overstimulating environment. Our staff recognized that children with autism respond well to heat and pressure as it mimics the most basic and intrinsic feeling of security, safety, and love.  Our patient was wrapped in warm blankets and rocked to sleep by our staff. The compassionate nature and commitment our CPS staff shows to their patients every day is truly special. This patient felt firsthand, snuggled in warm blankets and being rocked to sleep, the feeling of love, comfort, and security. The team recognized a deficit and went above and beyond to communicate and meet the needs of this child, which signifies the essence of team spirit.

Shortly thereafter, our patient was successfully transferred to a facility that could appropriately accommodate his needs. Through the team of Child Psych Specialists that Theresa cultivated and nurtured, they were able to de-escalate the situation and establish a relationship, even if it was for a short time.