Behavioral health consultants now working on inpatient units

By Francie Williamson, Communications Coordinator, Department of Psychiatry

It’s been a year now since the Department of Psychiatry at University of Iowa Hospitals & Clinics began rolling out a new care model, and that model is now being introduced into more inpatient units.

Several behavioral health consultants (BHCs) began their work in March 2021 when the department’s newest unit opened on the seventh floor of the Roy Carver Pavilion (RCP). Nearly a year later, more BHCs have been hired and in addition to the seventh floor of RCP, they now work on the first and second floors of the John Pappajohn Pavilion (JPP) as well as the third floor of Boyd Tower (3BT).

Evolution toward BHCs

The idea of a BHC isn’t new. The UI’s Intellectual Disability-Mental Illness (IDMI) Program has employed a BHC since 2015, says Kelly Vinquist, PhD, Clinical Associate Professor of Psychiatry and co-director of the IDMI program. However, it is not a common position in mental health care. 

The idea to expand the number of BHCs at UI came after Vinquist and James Burkhalter, LISW, a clinical social worker in the department, received a pilot grant in 2018 to gather data about the frequency of restraint and seclusion on the unit and how the department could possibly reduce the occurrence of “Code Greens”, or behavioral health emergencies.

“We found Code Greens were higher when there was not much available [for the patients] to do,” Vinquist says. “We were able to tailor it down to certain hours that seemed to be more difficult.”

At about the same time, Heidi Robinson, RN, the nurse manager for behavioral health, was beginning to look at staffing models for the behavioral health units, and learned about the BHC position.

“The acuity of our patients has changed tremendously, and the landscape of mental health care is a whole new ballgame,” Robinson says. “Being in the hospital can be a stressful experience, especially for people with mental health issues. We needed to find an innovative way to support our patients’ mental health issues before they hit a crisis point, which is where the behavioral health consultant comes into play.”

The role of a BHC

To be hired as a BHC, one needs to have a bachelor’s degree and a background in either education, psychology or social work as well as experience managing or helping people with challenging behaviors.

“Some of our nursing assistants do have a bachelor’s degree or experience with individuals with challenging behaviors, but we wanted to cement that into the BHC role,” Robinson says. “Now there is an opportunity for professional nursing assistants (PNAs) to get that bachelor’s degree and if they want to continue working in this setting, this would be an opportunity for them to advance within the organization.”

The BHCs wear plain clothes instead of scrubs and do a number of different things on the units, including recording observations for care plans and leading behavioral focused programming and prevention of challenging behaviors.

Enjoying the experience

Ashley Ogden and Sarah Godsil were among the first BHCs hired for the seventh floor of RCP back in March 2021. Both received their bachelor’s degrees from Iowa, Ogden in social work and Godsil in psychology.

Ogden says when she saw the job description, it checked all of her boxes.

“I think what drew me to it was the patient population that I’d be able to reach. I wanted to reach a wider set of people and get more hands-on experience.”

Godsil also says she thought the job description was interesting.

“The fact that it was a completely new position and they told us to make it our own, I thought was great,” Godsil says.

After a year as BHCs, Ogden and Godsil say they feel their work on the unit is very collaborative.

“It’s kind of a catch all kind of role to me,” Ogden says. “On any given day, I’ll get people hot cocoas or take their dirty trays, and then I’ll go into a patient’s room with them and let them talk to me and vent and I’ll practice coping skills with them, like breathing techniques. We really get to spend time with people and build a rapport.”

Ogden says the BHCs also have different roles depending on the unit they serve.

“On 7RCP, we’re all pretty much doing the same thing, but if you go to the child psychiatry unit, they’re doing a whole different thing,” Ogden says. “But they’re meeting the demands of the population, whatever the need is for that unit.”

Jeff Lees works on 3BT, which is the latest unit to get a BHC. Because the unit is a combined medicine and psychiatry unit, Lees says his time is spent more at the patients’ bedsides.

“I’m grateful for the role and the opportunity to be part of a team,” Lees says. “The nurses and nurse assistants have a lot on their plate and on our unit there’s a lot of high medical needs. So having somebody on the unit that is free to go room to room or hang out in the day room and address needs individually I think has been helpful.”

What’s next for BHCs?

The BHCs receive weekly training with Vinquist and Dr. Sara Wise, to expand their knowledge of therapy modalities and strategies to use on the units. Vinquist also credits much of the success of the BHC model so far to the collaboration between the psychiatry department and nursing.

Robinson says she would love to hire more BHCs.

“I’m really relying on this core group, looking at outcomes and making sure we can prove that they’re really successful, and then start getting some of our PNAs into the BHC role,” Robinson says. “I don’t see all of our PNAs going away, because I think we still need them to do some of those task-oriented type of things.”

Robinson also says there is an opportunity to do more research on the BHC role, and the staff is thinking of taking data and showing how the BHC role has been able to help units.

Peg Nopoulos, chair of the Department of Psychiatry, says when others ask what innovation is occurring in the department, adding BHCs is at the top of her list.

“They’re not that common and we are on the cutting edge,” she says. “It’s not that we’re catching up with people that are already doing it. We’re leading.”

Monday, March 21, 2022