Checking In – a Day in the Life of a Behavioral Emergency Response Team Member at Arkansas Children’s Hospital

For Amanda Alls, LCSW, behavioral emergency response team (BERT) team member and behavioral health technician supervisor, the first day of Thanksgiving week 2023 was a day of prevention rather than a day of emergencies. The BERT team supports patients with mental health needs, including those who might hurt themselves or be aggressive with others. One key intervention strategy is regularly checking in with patients and other team members. 

"We try to be all over," Alls said. "The more we check in, the more we can prevent something." 

What does it mean to check in? 

When Alls' shift begins at 6 a.m., 'checking in' means reviewing reports and medical charts from the night shift. Notes from colleagues may indicate if a patient with mental health needs arrived in the emergency department overnight, or if a patient is having emotional or mental difficulties after treatment. 

BERT team members are called to departments throughout the hospital for various reasons, including: 

• Assisting patients experiencing confusion or delirium after surgery 
• Supporting patients with autism, anxiety, depression or other conditions impacting emotional and mental health 
• Deescalating patients or caregivers experiencing stress or frustration 

Stabilizing a patient's mental or emotional condition is a crucial piece of the medical care they'll receive for physical conditions ranging from broken bones to kidney transplants. Mental health and physical health often directly impact each other. For example, a person experiencing chronic pain may be prone to depression. Studies show possible links between anxiety disorders and arthritis, gastrointestinal conditions and migraines. 

Arkansas Children’s created the BERT team as part of a strategy to address the emotional health needs of children.

Huddles and Rounding 

After reviewing medical charts and reports from the night shift, Alls does the administrative tasks necessary to coordinate care for complex medical and behavioral health patients. She also schedules interviews for those wanting to join the behavioral health team. By mid-morning, it's time for the daily huddle - a regular meeting that ensures team members can share the latest updates from their section of the hospital. These meetings provide another opportunity for Alls to check in with colleagues to identify where patients with mental health needs might benefit from support. Calls for BERT team members come from every department in ACH at any time of day or night.  

Alls said, “The critical piece of our team’s success is those relationships of checking in with social work, checking in with nursing, checking in with different units and the behavioral health technicians.” 

Sometimes, stabilizing patients mentally and emotionally means bringing them a sensory tool, like a fidget spinner or stress ball. Other times, it means delivering a favorite snack or drink. Child Life specialists and the BERT team have worked together to stock supplies in every hospital unit for quick access. 

BERT team members are always prepared to respond to emergencies, but one of their primary goals is preventing behavioral emergencies. One strategy for achieving that goal is rounding - walking the halls of the hospital and taking the time to listen. 

On the day we shadowed her, Alls checked in with long-term patients and a new patient in the emergency room. Observing Alls visit patients is a study in the art of listening. Her conversations are thoughtful explorations of stress that might be building or positive interactions that can become the foundation for growth and progress. A standard "How's your day?" evolves into an offer to use roleplay to prepare for a potentially difficult conversation the patient expects to have with an adult later in the day. With another patient, she wheels them through the halls to give them time outside their room. These moments release pressure before it becomes aggressive.  

Alls pointed to specific training BERT team members receive for emergency situations. "We're equipped physically and emotionally to handle [mental health outbursts.]" 

Alls checks in with staff, too. She visits behavioral health technicians and nurses in the emergency room, even though there are no urgent mental health needs. The team members share strategies they've already used. When Alls follows up, a patient's mother describes the behavioral health technician's interactions as "a kind of magic" as their child waits calmly to receive medical treatment. 

Arkansas Children’s Hospital provides BERT services 24 hours a day, 7 days a week, 365 days a year.