Underweight and dehydrated from frequent vomiting, Mary, 15, was admitted to Children’s Hospital of Philadelphia for evaluation. Her medical team was concerned about her ability to eat safely and suspected she might need surgery to reconstruct part of her airway. But there was a roadblock to providing effective care for Mary: She had severe developmental delays, resulting in behavioral issues that made examining and treating her a challenge.
Mary’s combination of medical problems and behavioral issues made her a perfect candidate for the newly opened 10-bed Medical Behavioral Unit (MBU), a unique collaboration between the departments of Pediatrics and Psychiatry. “The MBU is specifically geared toward helping kids whose behavior is interfering with their medical care,” says Psychiatrist Katie Hoeveler, MD, the unit’s Co–medical Director along with Pediatrician Stephanie Doupnik, MD. Potential patients could be a teen with a liver injury sustained after attempting suicide by ingesting acetaminophen or a child with diabetes who also has debilitating anxiety.
Marla L. Vanore, RN, MHA, guided the creation of the Medical Behavioral Unit.
Extensive research went into the MBU’s design. When Marla L. Vanore, RN, MHA, Director of Nursing, was brought in to head up the project two years ago, she immediately looked for other medical institutions that had done something similar. “I could find no one who had designed a unit like this,” she says. “We were the first.”
Safety in the details
Every component, from the beds to the bathroom fixtures, was carefully selected for maximum safety. “We acquired samples and did numerous simulations,” says Vanore. The doors can’t catch fingers. Clocks are encased behind glass. Shower curtains hang on magnets. Automatic lights follow a circadian rhythm, at night becoming dim but never turning off completely.
The unit features a forest theme.
The overall atmosphere, full of natural light and decorated with a forest theme, is meant to reduce anxiety. When able, patients can spend time alone in a small comfort room, or they can interact with a calming bubble tube and a fiber optic display in a multisensory room.
Previously, children in the Hospital with behavioral issues would receive separate visits from multidisciplinary team members. The MBU consolidates that care. “When a psychiatrist and a pediatrician are working side by side with a psychologist, a board-certified behavioral analyst, a social worker and a child life specialist, these kids receive the best care possible,” says Hoeveler.
For Mary, the concentrated approach worked. A behavioral assessment and intervention allowed team members from Speech, Gastroenterology and Pulmonary Medicine to complete evaluations. With medications and a new feeding tube, she got rehydrated and was discharged — without the need for any surgery.