This is Laura Dierda with the Beckley Healthcare
podcast. I'm thrilled today to be joined by
doctor Katie Hinderer, senior nurse scientist at the
Institute of Nursing Research and Evidence Based Practice,
as well as associate chair of nursing research
at the Connecticut Children's Research Institute. Doctor Hinder,
it's a pleasure to have you on the
podcast today. Thanks. I'm really excited to be
here.
Absolutely. And I'm looking forward to connecting with
you as well. I know we're gonna go
over some really important, information here about pediatric
mental health.
So this is going to be a podcast
that really
touches on so many different aspects of care
that are important to all communities. But before
we dive in, I'm wondering, can you tell
us a little bit more about yourself and
your career journey?
Sure.
So I am currently a nurse scientist in
a pediatric health center,
at Connecticut Children's, which is in Hartford, Connecticut.
I started out my career as a nurse
in actually adult health ICU
and worked at the bedside
for a while,
before I realized that there were other things
in my future. I was always really interested
in education and research.
So I, shifted gears and went and taught
at Salisbury University and their school of nursing
at Salisbury, Maryland for a while.
While I was there, I had the
unique opportunity to work with some of the
nurses at one of the local hospitals
in Salisbury, and
I really found myself enjoying that time connecting
with the clinical nurses,
talking to them about the real issues that
were going on at the bedside,
and just being able to spend time with
them and actually support them in research and
evidence based practice that they were interested in
doing.
So as a result, I ended up,
transitioning my career again
and,
was able to accept this position as a
nurse scientist at Connecticut Children's, and I've since
been able to grow in that role as
well.
I think I like to say one of
the best parts about my job is working
with clinical
teams and especially I love working with nurses,
of course,
to really support research questions that make a
difference,
in the care of children and their families
at the bedside.
So,
that's kind of what got me to where
I am now, and I really
love being a nurse and love working with
nurses and,
particularly love being able to do research
in the pediatric
world.
That's amazing to hear. And what a great
journey that you've had over time within the
clinical space as well as leadership and research
and more. It just really makes a big
difference on the type of care that we're
able to provide to, especially, pediatric patients.
Now I I know,
we we've recently,
done a lot of work around, some pediatric
mental health and behavioral health. And so I
was wondering if you could tell us a
little bit about that and, you know, what
really, you're seeing out there in the space.
What's, you know, top of mind is some
of the biggest challenges,
that you're encountering.
Absolutely.
So
we know that even before the COVID pandemic
started, pediatric mental health
was facing significant challenges in terms of not
having enough resources
to really
adequately care for kids and families of kids
that have
mental health and behavioral health concerns.
So leading up to the pandemic,
we already were resource poor in this area
as,
a country in general.
Once COVID hit, we started to see really
significant impacts in the mental health of of
everybody.
But we were really specifically focused in on
children and adolescents and even young adults that
were presenting to,
our medical center with different
mental and behavioral health concerns.
At the time,
we were fortunate enough to receive some funding
to
start looking at better ways to be able
to care for kids who are suffering from
mental health and behavioral health concerns.
So we initially wanted to look at how
can
the nurse at the bedside
better
assess a child that comes into the emergency
department
and better be able to
tailor their care to make sure that the
needs of that child and their family are
being met,
to the the best of our ability.
Obviously, we don't want children to have to
come to the ER for mental health,
but sometimes this happens.
And at the time during the pandemic, we
were seeing a lot of kids coming in
with,
mental health chief complaints.
As nurses, we really wanted to look at
what we could do to improve the practice.
The great thing about the team that was
built at the time was that it was
really led by our
nurse manager of the emergency department
and also our senior director of,
emergency medicine. So we have a really nice
interprofessional
team that approached
this care from a lot of different lenses.
We also,
were able to take this work and develop
a tool, which is what we kind of
came up with as a result of this
initial study. And the tool that we developed
is called the emergency behavioral health assessment tool.
The
nice thing about the emergency behavioral mental health
assessment tool, or as we lovingly call it,
the EBAT, is that it provides nurses
with a nursing assessment instrument
to help them,
sort of best categorize where the needs of
the child are at the time. And then
it also helps direct nurses
towards what kinds of nursing interventions we can
do to help support those children.
It also allows for our leadership team to
have a real time capture of what's going
on in the unit as far as the
children that have,
mental health concerns.
And it also allows us an opportunity to
help to make the case for resources we
might need for the kids. So for example,
if we have kids that need,
one to one observation and you need to
have staff there to be able to sit
with the children and and watch them,
this tool provides that kind of objective assessment
of that so that they can really do
those, get those things that they need.
Our, physician provider, who's doctor Steve Rogers,
likes to call it a vital science for
mental health. And it is kind of like
that, but I look at it as a
little more than that. In that, it's giving
our nurses tools to help quantify, you know,
what's going on with their patients and then
help guide them in their practice.
That's amazing. And, you know, really helpful to
understand impact of what a tool like this
can do in order to,
you know, deliver the right care and make
sure that the nurses have what they need
in order to,
direct the patients and get them into the
space that they need to get in, so
that, you know, they're able
to start whatever treatments they need or or,
you know, really
have that kind of, like, care that is
so important to them.
I'm curious, you know, in looking at this
tool,
how did you develop it? What was that
process like? And then,
are there any,
results that you can share with us from
how it's been working out so far?
Sure. So, the tool was really as I
said, it was actually the brainchild of our
nurse leader at the time,
Ryan O'Donnell,
and also one of the clinical nurses who
was working primarily with this population.
And so
they kind of decided we need to do
this thing, and then this team sort of
organically came together. We just sort of started
plugging away at it during the pandemic.
Fortunately or not fortunately,
because things were escalating so quickly with pediatric
mental health at that time, that enabled us
to be able to really
hone in and focus on this project and
get it done relatively quickly.
I think some of the things and the
good outcomes that we've seen from this tool
are that,
it gives us a
sort of ongoing
ability to assess patients where they are at
the very
moment of care that you're with them. So,
for example,
when kids typically present to the emergency department
or any patient presents the emergency department,
they get a one time sort of assessment
that gives the overall sort of level of
acuity of the patient.
But that is a static measure and it
doesn't change.
And we know with a lot of health
conditions, but particularly with kids in mental health,
that their condition can change a lot over
the course of time that they're, you know,
maybe being seen in the emergency department.
So this tool allows us that flexibility to
be able to continue to reassess the patient
and say, okay, well now, you know, their
acuity is a little bit lower. So maybe
they don't need the intense interventions that we
were doing a little bit earlier. Or maybe
now their acuity is is going up and
they're, you know, getting upset or other things
are happening. So we need to kind of
intervene a little bit more with those kids.
And the other thing that we found in
our own,
practice was that we were able to significantly
reduce the amount of
restraint use and the amount of,
other types
of restraint devices
on the kids who were in the mental
health area. So what it did, I think,
was allowed us to
identify
better ways to help kids who were struggling
with mental health.
And it allowed us more opportunity to be
able to provide that one on one observation
and allowed us to really back away from
the use of,
as many restraints,
in the patients, which is always some like,
a goal. We don't want to ever have
to do that. And sometimes for safety, that's
something that we have to do. But I
think that that, to me, has been one
of the most amazing outcomes of this project
is that we were really able to significantly
drop that number.
That's amazing to hear. And, you know, what
a significant,
action to be able to take. And like
you said, reducing that number of children in
restraints,
I I can imagine that makes a really
big difference for those patients and their families
as they're going through their care journeys with
you.
I am curious, you know, for other clinicians
out there in hospitals or or systems that
are experiencing
similar challenges to what you have described at
the beginning of our conversation,
what can they do to develop something similar
or or really,
be able to start moving in this direction
of being able to,
understand patients better and then, you know, have
a a a tool of their own that
they can assess in real time?
So I think there were
many things that we did as an organization
at Connecticut Children's to better support pediatric mental
health
that happened along with the development of the
tool. As I said, with this tool, we
were able to quantify getting more resources that
were tailored towards mental health. So we were
able to hire
more individuals
who could sit with the patients. We were
able to hire more nurses with specialized training.
We were able to bring in some different
training programs for our teams, which really, I
think, helped. So I think as organizations are
looking at this,
always focusing on, you know, what are the
real resources you need and then trying to
get get those resources. I think that this
allowed our nursing leadership team to have the
data to support the need for some of
those things that they were able to to
get.
We are currently working
now. We have some new funding, which is
from the Heilbronner
Scholar
Award from Rockefeller University.
And we're actually working to do some further
validation testing of our tool.
Over the course of the next year, we're
gonna be doing a study that's gonna look
at
the tool itself. We're gonna be doing some
different types of statistical tests to see,
how well the tool is performing.
And we hope to really be able to
have a nice final product at the end
of the year that we can share with
other institutions.
This to me is really exciting because there
really aren't a lot of tools out there
that are like what we're we're offering,
in our tool. And I think it's gonna
provide
a nice way
to, you know, say this is a good
tool. It's reliable. It's valid. And it's something
that can be used in other institutions as
well.
As a scientist,
nobody ever likes to create their own measures
and especially the homegrown measure thing isn't always
the best approach,
even though sometimes people have to do that.
But I think the work that we're gonna
be doing this year is even more exciting
because we're gonna be really
trying to further support and make the best
tool possible so that other institutions across the
country can use
this tool to support their own nursing practice.
I love that. Thank you so much for
digging a little bit deeper there and explaining
just everything that goes into developing a program
and tool, that's transformative
for those youth mental health patients.
Before we wrap up here, I wanted to
get your,
your thoughts on what's next. Where do you
see the space of youth mental health headed
and especially
how are things changing at Connecticut Children's?
Of course.
So as a a nurse, I'm always a
nurse first, and then also as a scientist,
my dream is that, you know, we don't
have to treat as many children in the
emergency department with, mental health concerns.
I hope that in the future, the research
we're doing and research that others are doing
are gonna help
to, you know, decrease the need for kids
to come to the emergency department when they're
having mental health
concerns. And I'm hoping that, you know, we'll
be able to strengthen our community based resources
so that kids can get the care they
need in their own communities, in their own
homes.
That's kind of my dream for where youth
mental health is gonna go. It's probably gonna
take a lifetime to finish that work, but,
that's kind of what I think. At Connecticut
Children's, I think we're continuing to really focus
on a lot of different aspects of youth
mental health. We've recently opened a suicide prevention
center. We have a lot of other work
being done in the mental health space, both
in the emergency department,
and also on our inpatient side of care
as well,
and partnering with other institutions and organizations across
the state to really help promote,
youth mental health.
I'm hoping that, you know, as a nurse
scientist,
my impact on this research would be just
to really improve the practice and the care
that these kids receive.
Because a lot of times, you know, kids
can be very marginalized that have mental health
conditions. Actually, anybody that has a mental health
condition can be marginalized.
A lot of people don't understand,
mental health conditions or have empathy for folks
that have mental health conditions.
And I'm hoping that through the work that
we're doing, we're just gonna help improve the
care of those kids so that they can
get, to where they need to be, so
they can try to really
get towards mental wellness,
and to a place where they, you know,
will be able to continue to function and
live in their schools and their communities and
and not have to visit us in the
ER.
I love that. Doctor Hinder, thank you so
much for joining us on the podcast today.
This has been such a fun conversation, really
inspiring and informative, and I look forward to
connecting with you again soon. Thank you so
much. It was great being here too.