Members of the CCH Behavioral Response Team
The patient had dementia and was a bit confused, and they wanted to leave the hospital—now. They started to become verbally aggressive to the care staff and threatened to leave, even though they still needed more treatment for an infection.
That’s when nursing staff called Penn Medicine Chester County Hospital’s newly formed Behavioral Response Team, to see if they could help.
Members of the team arrived quickly and assessed the situation. This time, a mental health technician from the team sat and struck up a conversation about a topic that was near and dear to the patient. This simple, yet profound, connection de-escalated the situation and helped the nursing staff better care for and support their patient. As a result, the patient completed treatment without issue and was discharged safely.
This type of rapid, on-the-spot help is especially important to staff because, sometimes, patients who are in psychological distress can become violent. Situations like these are why Chester County Hospital created the Behavioral Response Team—to provide both staff and patients with resources and solutions when patients show signs of behavior that might turn violent.
The Behavioral Response Team is just one of the ways Penn Medicine is working to bolster employee safety. Across the system, efforts include a $28 million investment in Evolv Technology security systems, de-escalation training programs for hundreds of front-line staff, and the distribution of duress badges to clinical staff members.
Getting started
The team began as a pilot program in July 2023 designed to be a real-time, in-person response to actively step in to help with a patient who is identified as showing signs of possible escalation related to psychiatric illness or behaviors.
Chester County Hospital leaders, along with the Behavioral Health Department, recognized the need for additional resources. The hospital commissioned an outside consultant to conduct a behavioral health and workplace violence risk assessment, which included interviews with front-line staff and leaders, as well as a review of the hospital’s environment and policies.
“We wanted to focus on a proactive approach,” said Kyle Finucane, MSW, director of Behavioral Health for the hospital. “The Behavioral Response Team was initiated with the goals of decreasing incidents and increasing the frontline staff’s toolkit and confidence in working with patients with behavioral needs, with the ultimate goal of decreasing episodes of workplace violence.”
During the program’s nine-month pilot period, the team was available on three inpatient units Monday through Friday between the hours of 8 a.m. and 4 p.m. The impact was clear: The hospital saw a 70 percent decrease in agitation among patients after a team member intervened. Armed with these results, hospital leaders decided to expand the program in April 2024 to be available 24 hours, 7 days a week to all inpatient units.
How the Behavioral Response Team operates
Members of the Behavioral Response Team, along with the unit charge nurse, respond to an alert and provide care to their patient
Dealing with behavioral issues requires specialized training, and the team members are well-equipped to support patients and front-line staff. All responders have completed a competency training course which covers verbal de-escalation, physical self-defense skills, and an overview of hospital resources that staff can use to support patients, such as spiritual care and counseling. They also complete simulations of possible behavioral response situations, such as a patient experiencing delirium due to illness, a patient refusing to engage with their treatment team, and a patient with a substance use disorder requesting to leave against medical advice. As part of their training, new team members must also shadow current team members on calls throughout the hospital.
“In my years of working as a social worker, both in the Emergency Department and on the units, I quickly realized how crucial an early intervention was to help de-escalate behavioral outbursts and challenging situations,” said behavioral health supervisor Patrick Johnson, MSW. “The Behavioral Response Team can act as that additional layer of support to help our treatment teams more effectively manage and care for our patients.”
The response team is made up of 20 members of the hospital’s Behavioral Health department, including social workers and mental health technicians, who provide around-the-clock coverage to hospital staff and patients. Once the team is paged by a staff member in need of support, a behavioral health social worker and a mental health technician arrive at the unit within 15 minutes and work with the staff member to understand the needs of the patient. The specialized responders then assist the patient to de-escalate any issues. Some responses to an alert can include discussing coping skills with the patient, leveraging Verbal Judo to de-escalate, working with the clinical team about the need for medication management, or expediting consults with mental health counselors. After they have intervened, they will check in with the unit four hours later to see if additional resources are needed.
The calls vary in cause and severity, said Samantha Dawson, LCSW, a behavioral health supervisor and a member of the response team.
“The Behavioral Response Team is often called for patients dealing with dementia who just need a new face to talk to and provide distraction and engagement; other times the calls are related to a patient not feeling heard,” she said. “Each time we complete a call, I feel as though the patient is appreciative of feeling advocated for, and the staff feels like they have a new direction, and that is imperative for an ongoing working relationship.”
Commitment to help in the face of rising mental health needs
Mental health issues have been on the rise, nationally and locally, since the COVID-19 pandemic, and the health care sector as a whole has struggled to keep up with growing community needs. Support for patients with behavioral issues at Chester County Hospital is a significant help in a community where the closure of other local hospitals has meant patients have fewer resources for mental health care. Chester County Hospital has experienced a 73 percent increase in community members seeking help for a behavioral health–related crisis since the closures of two surrounding community hospitals at the beginning of 2022.
In addition to the new Behavioral Response Team, the hospital’s Behavioral Health Department also provides non-urgent consultation services for patients in the hospital who are experiencing any mental health complication during their time in the hospital, similar to consult services at other hospitals across Penn Medicine. Haven Behavioral Hospital of West Chester, an independent practice providing inpatient and 24/7 crisis walk-in mental health services, is also located on the campus of Chester County Hospital.
Continuing to invest in mental health support to address the rise in community needs is important to Penn Medicine across many care settings, both in the hospital and in the community. Other recent additions include a second Penn Medicine Crisis Response Center opened at the Hospital of the University of Pennsylvania – Cedar Avenue (HUP-Cedar) in 2023, and a new behavioral health crisis walk-in center due to open at Penn Medicine Lancaster General Hospital in 2025.
Teamwork makes the dream work
Director of the Behavioral Response Team, Kyle Finucane, and one of the team’s developers, Kimberly Joffe.
Since the Behavioral Response Team launched at Chester County Hospital, staff report feeling like they’re more supported in challenging situations and say they’re working in an even more collaborative environment. Kimberly Joffe, CRNP, consult-liaison psychiatry lead and one of the developers of the behavioral response team, says that she has seen an increase in staff preparedness, awareness, and overall comfort level when dealing with de-escalations, thanks to the Behavioral Response Team.
Staff have also said patients have expressed their appreciation of not only feeling heard but having additional options or resources that can enhance their care.
“This program has helped our team in many difficult situations,” said Nicole Eastburn, RN. “The Behavioral Response Team is extremely supportive of both nurses and our patients alike.”