Building Better Inpatient Mental Health Outcomes at College Hill
The lobby of the William K. Schubert, MD, Mental Health Center at College Hill is filled with natural light that contributes to its spacious and airy feel.
Building Better Inpatient Mental Health Outcomes at College Hill
The lobby of the William K. Schubert, MD, Mental Health Center at College Hill is filled with natural light that contributes to its spacious and airy feel.
In the late 19th century, American architect Louis Sullivan coined the phrase “form follows function.” His mentee, Frank Lloyd Wright, went on to slightly modify it, saying “form and function are one”—that they should exist in harmony.
This concept is at the heart of the new William K. Schubert, MD, Mental Health Center in College Hill. While the form of the building is visibly impressive, with more space, more light, more rooms and more facilities, its intent goes far beyond the aesthetic.
Cincinnati Children’s was already the largest inpatient pediatric mental health provider in the United States, but the type of care we were providing was rapidly outgrowing the building it was offered in. “The units were set up based on a 1980s-type philosophy where you have bedrooms surrounding one moderately-sized room in the center where everything occurs—where the kids eat, where they do groups, where activities are,” says Aaron Vaughn, PhD, a clinical pediatric psychologist and professor in the Division of Behavioral Medicine and Clinical Psychology, as well as senior director of Behavioral Health Programming. “But if one of the kids was struggling and started yelling and being disruptive, then the activity or program would stop for the entire group because there was nowhere else to go aside from back to their bedrooms.”
“Our objective is to keep our patients focused on treatment as much as possible,” says Sandy McCarley, DPN, RN, clinical director in the Child Psychiatry Program. “We’ve noticed that, not only do our kids do better when they're in more programming, but it's a safer environment for everyone—emotionally, psychologically and physically. We see fewer injuries and incidents when the kids are engaged in an activity in a safe, stable, nurturing environment.”
Pioneering a New Care Model at College Hill
Long before the official opening of the new building in October, staff at College Hill were “thinking outside the room” and starting to implement a new care model for inpatients. In January 2019, an innovative project team comprised of Sandy, Aaron, Cassandra Esposito, PhD, Katie Lee, MD, and Tiffany Fread, LISW-S, launched the Pioneer Program with their youngest patients, ages 3-9. “This is an age group that is constantly seeking engagement, wanting to be in their treatment and programming,” says Sandy. “And we had a team that was ready to start making some changes in the programming schedule, to try new approaches with the staff and the kids in that unit. That developed into our Foundations of Care, which then spread throughout the rest of the child program and into our adolescent program in 2021.”
“And once it spread, it became more than a program—it became who we are,” says Brittney Jones, BSN, RN, clinical director in the Adolescent Psychiatry Program. “Every time we introduced it to a new team or group, we elevated it and we learned from what we had done before.” They also were able to move faster each time. The initial model took many months to fully implement in the child program, but when they rolled it out to the first unit in the adolescent program, they were able to do it in 12 weeks.
“Now, every day our kids have a very regimented schedule that they follow from the time they wake up until they go to bed,” says Brittney. “Every 45 minutes we are running a program with them, or we're doing a therapeutic activity with them. Because the more you engage the patients, and the more you build rapport with the patients, the more successful they are in their treatment.” As our mental healthcare teams started to introduce more therapeutic groups, creative expression groups, social-emotional groups, and games and activities to structure the day, they still had to do so within the confines of the small, central rooms. But the new building has been designed with dedicated rooms for different types of programming. For example, the art room is reserved for art therapy, and all the materials are kept there—it’s not a space for eating or for schoolwork, it’s where staff and patients can focus on art.
“Now if a kid is struggling, there are other rooms and other spaces where they can go to with a staff member to de-escalate, and they can get the support they need before rejoining the group, but the other kids can keep participating in treatment versus going back to their bedrooms,” says Aaron. “That's when we see the number of escalations going down. And we see shorter lengths of stay—patients are able to discharge more quickly. Getting kids healthy enough to go back to their homes, schools and communities is the goal of the entire program.”
“Now that we have the new building in which to apply our new care model, the environment matches our intention of treatment,” says Sandy.
“The facilities and capabilities within this building are a natural progression of what we've always wanted, and we've actualized it now,” says Brittney. “That's what's really exciting.”
Setting the Standard for the Field
As the importance of mental healthcare is becoming more known, accepted and discussed in current culture, the care and resources offered at the William K. Schubert, MD, Mental Health Center are increasingly recognized as integral to overall health and well-being.
The data show that there are fewer injuries and incidents when the kids are engaged in an activity in a safe, stable, nurturing environment.
Employees tour the new building, which has been designed with dedicated rooms for different types of programming.
“If you had a broken bone, you wouldn’t not go to the hospital and get it set and put a cast on it, right? So when you have a broken spirit or a broken heart, you should have somebody who can help you and support you through that,” says Brittney.
“And it's okay—it’s more than okay—to get that help,” says Sandy, noting that childhood and adolescence are especially critical times to identify and address mental illness.
“We are seeing some of the sickest kids in the United States here, the ones with a broad range of issues who are most in need of us being there for them,” says Aaron. “The weight of that responsibility is only manageable when you have that safe, stable and nurturing environment with a team that has a shared mindset about how to work with these kids who are in pain to help them get through it.”
As the staff spends time working in the building and experiencing how this care model works in the new environment, they’ll make observations, offer and solicit feedback, listen and learn, all with the aim of improving patient experiences and outcomes, and sharing that knowledge with others.
“We're not doing anything that is incredibly innovative from a treatment perspective,” says Aaron. “But no one's ever done it at this scale with this level of acuity and with this type of custom-designed building supporting them. I think everyone who will be building a large mental health building in the future will probably look at how we’re offering care in this building and learn from it.”
Members of the Schubert family pose for a photo at the grand opening of the new residential center named for their father and grandfather. They are (left to right): Bill Spreen, Nancy Schubert, Joanne Schubert, Aaron Perlman, Carol Schubert DiPilla, Victor DiPilla, Barb Schubert Nolte, Don Nolte, Will Nolte.
Our Proactive Approach to Addressing the Childhood Mental Health Crisis
At Cincinnati Children's, we experienced a 91% increase in children seeking emergency care for mental health crises from 2011 to 2017. This level of need has inspired action across our health system.
While we opened our expanded, state-of-the-art mental and behavioral care facility at College Hill, our overarching mission is to move care "upstream" to intervene before a child’s mental health problems become severe. Our blue-sky goal: to eliminate pediatric suicides by 2033.
Progress toward achieving these goals has involved substantial investment, sweeping practice changes, and groundbreaking research. Many of these efforts were recently published in "The Journal of Pediatrics."
Our approach includes four major changes.
- First, the Project ECHO program enhances the mental health skills of front-line care providers.
- Second, we are embedding psychologists in pediatric offices to offer immediate help and connect families to more intensive services when needed.
- Third, we are rethinking crisis care with the creation of our Bridge clinic and our Intensive Outpatient Program, which have begun reducing emergency department visits.
- Fourth, and still in development, experts here are working to improve early detection of mental health issues by using artificial intelligence technology to identify at-risk children much earlier than current methods.
Cincinnati Children's already serves as a national leader in mental health care and research for children and teens. We hope to serve as a model for other pediatric centers facing the same crisis in their communities, by developing and sharing best practices and innovations to improve parity in access, quality, and reimbursement between mental and physical healthcare.