December 1st, 2010

Unit uses softness to connect with kids

A Massachusetts-based child inpatient psychiatric unit is breaking from the traditional use of restrictions and seclusion for managing troubled patients with a much softer approach: colorful rooms, soft places to sit, listening ears and lots of hugs.

To be exact, the “Hugs not Holds” initiative is just one of several programs used to calm, quell and treat kids admitted to the Child Assessment Unit (CAU), an award-winning unit under the auspices of Cambridge Health Alliance that thinks outside the box when it comes to treating difficult patients.

The CAU opened in 1989 but underwent a major change in 2001 when a no restraint policy was implemented. Since then, the unit has honed its “Open Arms” approach that uses a collective problem-solving and trauma-informed care model. “Hugs not Holds” and the program “Listening not Lecturing” are two ways kids are taught to feel and hear the message that they’re in a safe place and cared about … even when they erupt in fits of uncontrolled anger from their mental illness.

“One of the things we do that’s unique in the unit is we try really hard to understand what the triggers are [for different patients] and we try not to complicate that, and [instead] respect that,” says Chris Pagano, Ph.D., the director of Child Inpatient Psychology Training at Cambridge Health Alliance, a staff psychologist at the unit and an assistant professor of psychology at Harvard Medical School.

“There’s something to be learned even when there’s difficulty,” says Pagano. Instead of restraining out-of-hand kids, they’re sent to the “sensory room” to help calm them down and explore what led to their tantrum.

“Kids definitely have said very clearly that they like it: they like knowing they’re not going to be restrained,” he says.

Kathy Regan, RN, agrees. The nurse manager who leads the unit says 50 years ago, protocols for caring for problem kids were much more humane than they were just 15. “Somehow, people started creating [child assessment] units based on a worse-case scenario,” she says. When you become that controlling and rigid, problems arise. That’s why this modern-day unit is such a positive thing.

“It’s been very, very exciting,” says Regan. “We’ve been really successful, [and] we know the approach works. We’d like to bring it to the rest of the world.”

The CAU operates within the Cambridge Health Alliance, an integrated healthcare system in Massachusetts that provides care in Cambridge, Somerville, and the metro-north communities of Boston. With three hospital campuses, specialty and primary care practices, the Cambridge Public Health Department and the Network Health Plan, the CHA is also associated with Harvard and Tufts.

In the summer, the CAU closed for three months for renovations and since then has enjoyed a major facelift replete with fresh paint, new lighting and carpets and revamped treatment and sensory rooms. Patient rooms got refinished bookshelves and beds … all in the name of healing in comfort and moving on in confidence.

By Jennifer E Chase

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