pe251 welcome to the pbmu - seattle children's

Welcome to the Psychiatry and Behavioral Medicine Unit

How to contact the unitPage 4

What to expect on the PBMUPage 4

How you can be involved0

Visiting and staying overnightPage 12

Keeping your child safePage 12

Other hospital resourcesPage 15

Patient and Family Education


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A note from parentsWelcome. If you and your child have just arrived here, it can be hard to know what to expect. You probably have a lot of questions and may feel overwhelmed. As parents, we did.

We’ve learned how important it is to take an active role in our children’s healthcare. We encourage you to trust your instincts, ask questions and share your concerns. It makes a difference. After all, you know your child best.

We know how tough caring for a sick child may be here at the hospital and at home. You are not alone. You can look to the staff to teach you about your child’s condition and help you find resources to care for your child after you leave.

This brochure answers basic questions we had during our stay. Hopefully it will do the same for you. If you have other questions or don’t understand something, ask anyone on your healthcare team.

We hope this helps you begin to find your way.

Sincerely,The Family Advisory Council

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Contents

How do I contact the unit? ...............................................4

How will the unit contact me? .........................................4

Care on the PBMU ................................................................4

Supervision ......................................................................... 5

Structure ..............................................................................6

Group Activities ................................................................ 7

Nursing Care ...................................................................... 7

Clinical Assessment ........................................................8

Identified Providers.........................................................9

How You Can Be Involved .......................................... 10

What if I have comments or concerns? ..............11

When may I be with my child? ..............................12

Safety Guidelines .................................................................12

Unit Safety .........................................................................12

Hospital Safety .................................................................13

Hospital Services .................................................................15


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How do I contact the unit and my child? • Call us at 206-987-2055 at any time (24 hours a day, 7 days a week). If you

have any questions about supervision, structure, group activities, or nursing care, ask any staff member or request to speak to the Charge Nurse.

• For questions about Clinical Assessment or Identified Providers, your primary point of contact is your child’s therapist. If you need help contacting them, contact a member of the Parent Support Team by calling 206-987-0208 or email [email protected]

• A member of our leadership team is on call 24 hours a day, 7 days a week. You can reach the Leader on Call (LOC or PBMU Leader) by calling 206-987-2000 and asking a staff member to page the PBMU Leader for you.

• The hospital offers free interpreter services. In the hospital, ask any member of your child’s care team. If you’re calling from outside the hospital, dial 1-866-583-1527 and tell them the name or extension you need.

How will the hospital contact me?Check in with our unit coordinator (at the family reception area) to make sure that we have your most up-to-date contact information. The contact information you give to the unit coordinator will be included in your child’s electronic medical record.

Care on the PBMUSee our handout “Care on the Psychiatry and Behavioral Medicine Unit (PBMU)” for a one-page overview of what you can expect on the unit.

What can I expect on the Psychiatry and Behavioral Medicine Unit?The Psychiatry and Behavioral Medicine Unit serves children and teens between 3 and 18 who are in psychiatric crisis. Our goal is to help stabilize your child’s behavior by dealing with their immediate crisis. After that, we work on returning your child to the community.

How long will my child stay on the unit?A stay on this unit is about 5 days on average and is based on medical need. This means most children and teens do not leave the hospital without symptoms. For many of our patients, the care plan will need to continue at home and in the community.

Our aim is to help you reduce these challenges over time. This will be more likely if the work we start here continues with your community providers.

What can my child bring to the Psychiatry and Behavioral Medicine Unit?See our handout “Patient and Visitor Information for the PBMU” (available in our family reception area, River 5) which lists items that are and are not allowed on the unit.

Contacting the PBMU

Psychiatry and Behavioral Medicine Unit

Level 5, River zone

206-987-2055

Parent Support 206-987-0208

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Visitors to the Psychiatry and Behavioral Medicine Unit are allowed to bring cell phones. If visitors bring any other items that are not allowed on the unit, parents or caregivers can store them in the parent lockers in the family reception area until they can be taken home. Our unit coordinator can help you with the lockers. The hospital is not responsible for lost or stolen items.

Supervision

How are patients supervised on the PBMU? All patients are supervised by PBMU staff according to the level of supervision necessary for their care. Patients are never left alone together, and they have access to staff at all time. Keeping our patients safe is our main priority.

What are some behaviors my child might witness?Our unit serves children and teens with emotional and behavioral symptoms. Your child could see behaviors you may find distressing. This may include the use of curse words, aggression, self-harm, purging, mania and psychosis.

“Our son calls the PBMU his safe place, where he knows when his own actions are dangerous, he can trust that there will be others to protect him, and staff (coaches, nurses, doctors, purple team) all treat him with compassion and respect. He now shares his experience with other youth to help alleviate their fears around seeking support.”

Former PBMU Parent


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What happens if a child is physically aggressive or tries to run away? The Psychiatry and Behavioral Medicine Unit maintains an environment that is free from seclusion and restraint. Instead, we use other interventions like coaching, redirection and modeling to help our patients.

However, in cases of extremely aggressive behavior that patients cannot manage through self-control, or that we cannot manage through standard interventions like coaching, we may have to physically restrain a patient. A doctor will authorize the use of restraints. Once it is safe, we will end the restraint.

If your child runs away from the unit, we will follow your child until support arrives. To keep your child here, we may need to use restraints. We will do this safely and follow Seattle Children’s Hospital Aggression Management procedures. If a child leaves the hospital, we will contact the Seattle Police Department. We will work with the police to accompany them back to the hospital.

How might the least-restrictive philosophy impact you and your child’s care?At times, areas of the unit will be temporarily closed for staff to provide additional support to escalated patients. This might mean that staff will ask parents and visitors to wait in the family reception area or in certain areas of the unit for a period of time. Additionally, staff may ask parents to wait to access their child’s room until the space has re-opened. While this may have some impact on the groups’ schedules, we work hard to ensure that it does not interfere with patient care.

This process of closing down spaces allows us to utilize the least restrictive intervention while ensuring a safe environment for all patients, visitors, and staff. We are dedicated to our philosophy of being seclusion and restraint free and we appreciate your patience and understanding.

Structure

What is my child’s daily schedule?Your child will be assigned to a peer group based on their age:

A – ages 3 to 9 B – ages 10 to 12 C – ages 13 to 15D – ages 16 and up

We also have separate groups for patients admitted for concerns of an eating disorder, an Autism spectrum diagnosis or a psychotic presentation. These patients will be assigned to a peer group based on age and other criteria.

Your child will attend skill-building groups and school with others in their peer group. Your child will take part in therapeutic activities and practice skills that will help them to be safer in the community.

We have copies of your child’s peer group schedule in our family reception area.

Questions?

Ask any staff member for questions about supervision, structure, and group activities.

Request to speak to the Charge Nurse.

Psychiatry and Behavioral Medicine Unit Level 5, River zone 206-987-2055

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Due to continual changes in the number of patients we serve, the age range in each group outlined above may shift slightly to help us appropriately manage the groups.

Group Activities

Solution-focused interventionsThe focus of the hospital stay is on solution-focused interventions. This includes developing new skills to cope with stress and get a better understanding of what is driving your child’s behavior. Children, teens and families can learn how to manage emotional and behavioral problems in a safe and caring environment.

What is the Psychiatry and Behavioral Medicine Unit program philosophy?We use a program based on a behavior management system of natural and logical consequences. Staff are “coaches” and promote three life standards and values:

• Respect self

• Respect others

• Respect community

Staff will teach, coach and reinforce emotion identification and regulation. This means being able to identify, name and manage emotions. They also will teach distress-tolerance (coping) skills like anger management, relaxation and social problem-solving skills.

Trigger CardsWe use Trigger Cards to help children, teens, and families learn about what causes emotional distress and how to cope with it. For more information, see our handout “How to Use Trigger Cards.” Trigger Cards are available at the Unit Coordinator Desk in the Family Reception Area and can also be printed from our website.

Nursing Care

Direct-care providersRegistered nurse: Responsible for the medical care given to patients during each shift. Leads the coaches and ensures that medical orders are followed. Registered Nurses also help pat ients in the same ways as coaches.

Coach: Pediatric Mental Health Specialists, called Coaches, assist patients in using coping skills to manage difficult situations and emotions. Coaches provide supervision for patients and support your child throughout the day.

Other things you can expect• We will check your child’s vital signs (temperature, breathing and heart

rate, and blood pressure) as ordered by the doctor. We will weigh your child 2 to 3 times per week.

“Coming to the PBMU saved my child’s life, no question. And the knowledge we gained during her stay will help us both navigate the world for the rest of our lives.”

Former PBMU Parent


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• At the end of their shift the coaches and nurses will “hand off,” meaning they will take 30 minutes to pass important information to the next coach or nurse.

• Handoff times are 7 a.m., 3 p.m. and 7 p.m. Please give non-urgent requests to your coach or nurse before or after these times. If you have an urgent request, please let us know.

• During handoff, your child will meet their new coach. If you have questions about your child’s medication schedule, ask a nurse or your child’s treatment team.

Clinical Assessment

How do we set goals for the hospital stay?When you arrive on the unit, a nurse will meet with you so you can share your immediate concerns about your child. Your child’s treatment team will work with you to decide what your child can accomplish during this short stay. They also will work with you on goals that will take longer to reach. Some goals require ongoing outpatient care.

Our goals are to:

• Stabilize your child’s immediate crisis

• Offer education about your child’s diagnosis and behaviors

• Assess if a medication might help manage your child’s symptoms

• Help build skills to manage crisis behaviors outside of the hospital

• Help your family access resources in the community

When will my child go home?Every patient is different. Most stays are less than a week, but it depends on your child’s situation. Each day we assess the need for your child to be in the hospital using a combination of documentation, observation, and interviews. We discharge children when ongoing hospitalization is no longer medically necessary.

From the moment your child is admitted, we will talk with you about what we need to do before your child may go home. We will answer your questions and provide you with needed resources. We will ask that you partner with us to schedule your child’s outpatient appointments. These appointments are crucial for your child’s care once they are home.

What if my child does not show the same behaviors on the PBMU as they do at home?Your child may not show the same distressing behaviors on the unit that they do at home, school or in the community. We cannot work on behaviors we do not see. We may have to send them home without ever seeing the behaviors that brought your child to the hospital. This can be frustrating to parents and caregivers.

Sometimes children and teens do not feel like their problems are as concerning as you and the outpatient providers feel they are. Because of this, children and teens sometimes refuse to participate in the treatment process. This can make it hard for us to accomplish as much as you or we would like.

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Our handout “Care on the PBMU” includes a checklist of action items that parents and caregivers can use to start planning for discharge at the beginning of your child’s stay.

Identified Providers

Your child’s healthcare teamChildren’s is a teaching hospital. Your child will receive care from a team that may include many doctors and staff members. Your primary point of contact is the therapist assigned for the day.

Treatment teamAttending doctor: Directs your child’s care and supervises the fellows and residents caring for your child.

Or ARNP: Licensed Advanced Registered Nurse Practitioner specializing in pediatric psychiatry.

Fellow or resident: Licensed doctor who is in training in a pediatric specialty. They work under the supervision of an attending doctor.

Mental health therapist: Works with you and your child to address treatment concerns, build coping skills, and make a plan to facilitate a safe transition to the community. The mental health therapist is your primary point of contact on the Clinical Team.

Parent support staff: Specially trained to work with you to prepare for post-hospital care. Helps identify your family’s needs and connects you with resources in the community.

We will give you a list of names and phone numbers of your child’s treatment team members – please refer to handout “Your Child’s Treatment Team.” Depending on your child’s needs, not all team members listed above may be involved in your child’s care.

Parents: you are an important part of your child’s treatment team. For ways to coordinate with your child’s team, see “How You Can Be Involved” section.

What does Outpatient Treatment typically look like?We believe children and teens are best treated in their communities. Typically, an outpatient team consists of a mental health therapist and a provider who manages medications. Please consult your PBMU Clinical Team or Outpatient Team if you have questions about more support or resources for your child in the community. There are a range of services available in different areas. We work with each community to help identify mental health services and resources for your child, and will share them with you. For help setting up mental health services, contact the Parent Support Team by calling 206-987-0208.


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How You Can Be Involved

How can I partner with my child’s treatment team?Because you know your child best, we hope you will take part in meetings with your treatment team and use this time to:

• Share your insights, questions and concerns with the care team; your primary point of contact for your child’s treatment team is the mental health therapist.

• Ask us to explain any terms that are not clear.

• Share any safety concerns you may have.

How can I help care for my child?You are an important member of your child’s healthcare team. You know your child best. We will work with you to make decisions and treatment plans for your child. You help your child when you:

• Tell us things that will help us to get to know and care for your child.

• Speak up right away when you have a question or concern. We expect you to have questions about your child’s care, and we want to hear them.

• Tell us if you think your child is in pain. We will make changes so your child is more comfortable.

• Speak up if you have a safety concern of any kind. Our number-one priority is to keep your child safe, and you are an important partner in being able to do this.

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What meetings should I attend? You will have two meetings with a member of the Parent Support Team. A Safety Meeting, preferably on the first day of admission, and a Crisis Prevention Plan (CPP) Meeting on the second day of admission. A member of the Parent Support Team will schedule these meetings with you.

You may have meetings with different members of your child’s treatment team. These may include a clinician, parent and caregiver support staff, or dietitian.

You will attend a Transition Planning Meeting with your child’s mental health therapist. The therapist will schedule this meeting with you.

We invite you to attend parent groups. In these groups, we will talk about the skills your child is learning on the unit. These will include things like:

• Trigger cards

• Distress-tolerance (coping) skills

• What you can do to help when your child becomes emotional or escalated

• Crisis-prevention planning

For a schedule of the parent groups, please ask the Unit Coordinator or contact the Parent Support Team.

What if I have comments or concerns? We strive to partner with families to provide the best care possible. We would like to hear from you. Our providers and staff expect that you will share your concerns so that we can better meet your needs and improve the services we offer all families.

During your visits with your child, you have the option of filling out a Parent/Caregiver Feedback Form so you can tell us how you think the visit went. If you are ever presented with a situation or a clinical practice that you are not comfortable with, we want to know. Our staff are specially trained to help resolve your concerns and involve others when needed. In addition, you are always welcome to escalate these concerns to the unit leadership (charge nurses, directors) directly or contact the Patient and Family Relations team in the hospital.

Here are some of the ways you can share your comments or concerns:

• Complete a Parent/Caregiver Feedback Form when you visit your child. These forms are available from the unit coordinator in our family reception area.

• Speak with a member of your child’s treatment team, such as your child’s mental health therapist (you may contact them via the number provided on the handout “Your Child’s Healthcare Team”).

• If members of your child’s treatment team are not able to help, ask to speak with unit leaders (charge nurses and leaders-on-call). A department leader is always on call. You can ask the charge nurse or unit coordinator to have them contact you.


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• If you’d like to speak to someone in your own language, call the Family Interpreting Line at 1-866-583-1527 and ask the interpreter to connect you with the appropriate staff member above.

• If you feel your concern is not being addressed, please contact the department leader who is on call. If we are still unable to help you, we will refer you to Patient and Family Relations at 206-987-2550.

• For complaints and resources about mental healthcare, visit www.kingcounty.gov, then type “ombuds” into the search box.

Other ways to submit comments and compliments

• Go to www.seattlechildrens.org/familyfeedback.

• Send an email to [email protected].

• Pick up a comment card located in our family reception area.

When may I be with my child?Parents, guardians or caregivers may be with their child anytime day or night. If you are here during group time or school, you may join in that activity with your child.

All other family members and visitors must check in at the unit coordinator’s desk each time they enter the unit. The visiting hours for visitors who are not caregivers are outlined in our handout “Patient and Visitor Information”. The unit coordinator will help you find your child on the unit. Everyone must wear their photo name badges at all times.

May I stay with my child overnight?We welcome you to stay with your child overnight and have room for one parent or legal guardian to sleep comfortably. Please see the charge nurse if a second adult wants to stay the night. Siblings and visitors may not stay overnight.

For your and your child’s safety, do not sleep on the floor. Do not sleep with your child in their bed or allow them to sleep with you.

For other lodging options, check with your treatment team.

Entering the hospital at night The River entrance is open 24 hours and is staffed by Security at night. The Ocean entrance closes at 10:30 p.m. on weekdays and 9 p.m. on weekends. At night, park in River Parking and enter the hospital at the River entrance. Take the River zone’s Frog elevator to level 5.

Safety GuidelinesPBMU Unit Safety

Unit dress codeAll patients on the Psychiatry and Behavioral Medicine Unit are expected to follow the unit’s dress code:

• Patients on this unit wear street clothes. They do not wear hospital gowns or scrubs, except for a small group of patients who are admitted through the medical service.

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• Shoes or slippers are worn to protect feet.

• Clothing related to cultural or religious practices is allowed.

• Clothing should be comfortable, modest and appropriate to the setting, which is similar to a school setting.

• Inappropriate clothing includes, but is not limited to:

• Clothing that is revealing. This includes low necklines, bare midsections, spaghetti straps, short skirts and clothing that is see-through.

• Tank top t-shirts

• Items with inappropriate messaging, cartoons or advertising

• Sagging pants – underwear should not show

• Bandanas and any other items that may signify gang involvement

If staff finds that an item does not follow the unit’s dress code, the item will be given to the parent or caregiver to take home.

Medicine safety• If your child needs medicine, we will work with you and your child’s

outpatient provider to make the best medication plan.

• If your child comes to the unit already on medication, your treatment team will contact you before making any changes to their plan. This includes starting a new medicine. If your child is not taking medicine, but we think they may need to, we will talk with you about the purpose, risks and benefits of the changes.

• We will ask you about medicines, vitamins and herbs your child is taking when you come into the hospital and again when you leave.

• Do not give your child any medicines, vitamins or herbs from your home supply.

• Your nurse is available to talk with you about each medicine we give to your child.

• Keep all medicines, diaper creams and other lotions away from small children.

Hospital Safety

How can I protect my child from infection?Children with an illness or injury may have a higher risk for infection while they are in the hospital. Follow these guidelines to keep your child and other patients safe:

• Wash your hands or use hand sanitizer gel each time you enter and leave your child’s room. Also, wash after sneezing, coughing or blowing your nose, and after wiping your child’s nose or helping them go to the bathroom.

• Sick people should not visit inpatients. If you are sick and must be with your child, talk with your child’s nurse about how to be with your child more safely.


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• Your child and family should not play with or visit other patients in their room or in the unit.

• Due to the hospital’s policy on infection prevention, if your child has an illness that others may catch, we will have them stay in their room until they are symptom-free for 48 hours. If this happens, your nurse will give you information about what to do.

• If your child is too ill to participate in Psychiatry and Behavioral Medicine Unit programming, your treatment team will talk about if your child is safe to go home.

How can I keep my child safe while in the hospital? Keeping your child safe is our main priority, but we also need your help. For your child’s health and safety:

• Make sure your child wears their medical ID band and that you wear your parent or caregiver name badge at all times. We will check your child’s ID before giving each medicine and doing tests or procedures.

• Taking pictures, video or audio recordings is not allowed.

• If an alarm on equipment sounds, let the nurse know right away.

• If you see that another child needs help, tell your child’s coach or nurse instead of helping the child yourself.

• Only Mylar (foil-type) balloons are allowed in the hospital to prevent choking.

• Talk with your nurse before you bring food for your child. Due to Department of Health regulations, we cannot store food for your child. If you bring food during a visit, we will ask you and your child to eat it at that time and take any leftovers home.

• All items brought for your child to the Psychiatry and Behavioral Medicine Unit must be searched by staff.

Protect your child from fallsIf your child is sick, injured, taking certain medicines or getting certain treatments, their chance of falling is greater. Your nurse will talk about how to prevent falls if your child is at risk.

• When your child is in bed, make sure the side rails or crib rails are raised and locked into place.

• Have your child wear non-skid slippers or shoes when they are out of bed.

• Always use seat belts on wheelchairs.

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What hospital services does Children’s provide? For more information on hospital services during your stay, talk with your treatment team.

We have copies of “Your Guide to Seattle Children’s” in our family reception area (River 5) and our family lounge (River 4) to look up information about:

• Social work, counseling, financial support and spiritual care

• Getting around the hospital

• Where to get food

• Places to stay

• Showers, laundry and other amenities at the Family Resource Center

• Phones, computers and Internet access

• Transportation

• Activities for your family

Interpreter ServicesThe hospital offers free interpreter services. Here’s how to contact them:

• In the hospital, ask your child’s nurse.

• From outside the hospital, call the toll-free Family Interpreting Line at 1-866-583-1527. Tell the interpreter the name or extension you need.

• For Deaf and hard of hearing services, dial 0 or 206-987-2000 and ask the hospital operator to page the Deaf and hard of hearing resource specialist.

4800 Sand Point Way NEPO Box 5371Seattle, WA 98145-5005

206-987-2000 1-866-987-2000 (Toll-free for business use only)1-866-583-1527 (Family Interpreting Line)

www.seattlechildrens.org

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Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the Family Resource Center at 206-987-2201.

This handbook has been reviewed by clinical staff at Seattle Children’s. However, your child’s needs are unique. Before you act or rely upon this information, please talk with your child’s healthcare provider.

© 2019 Seattle Children’s, Seattle, Washington. All rights reserved.

Free Interpreter Services

• In the hospital, ask your child’s nurse.

• From outside the hospital, call the toll-free Family Interpreting Line 1-866-583-1527. Tell the interpreter the name or extension you need.

To Learn More

• Psychiatry and Behavioral Medicine Unit Level 5, River zone 206-987-2055

• Ask your child’s healthcare provider

• seattlechildrens.org

pe251 welcome to the pbmu - seattle children's

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