Behavioral health challenges touch every corner of a children’s hospital.
As more children with complex behavioral health needs seek care, hospitals are rethinking how they prevent and respond to behavioral health crises, support staff, and create safer environments for everyone. Pediatric health care teams are building systems designed to identify risk earlier, coordinate responses, and learn from each incident.
Their work is making a difference.
At Children’s Nebraska, violent restraint events decreased nearly 24% from 2024 to 2025, while the average duration of those events fell 62.5%. Employee assaults in areas with a full year of the hospital’s Behavioral Escalation Prevention and Response team decreased 44.8% from the previous year.
And Children’s of Alabama saw a 61% decrease in patient behavioral events from 2024 to 2025 after implementing a hospital-wide pathway.
Here are five ways children's hospitals are strengthening behavioral health crisis response and protecting patients and staff.
1. Practicing high-stakes situations before they happen
Children’s of Alabama found 40% of its employee injuries were related to applying restraints.
Although staff members were expected to perform the high-stakes procedure correctly in stressful situations, they had few opportunities to practice it.
The hospital developed simulation training focused on deescalation and safe restraint applications. The training allows employees to make decisions, ask questions, and receive feedback in a controlled setting before an unpredictable event in patient care.
New employees participate in a common scenario in a training space designed to resemble a patient room, with an experienced staff member portraying the patient. After the simulation, facilitators ask participants to reflect on their actions, explain their decisions, and consider what they could do differently.
The training also reinforces the importance of giving deescalation strategies time to work. Early scenarios were designed to end in restraint so employees could practice the procedure. But some teams successfully deescalated the situation, prompting facilitators to allow time for verbal and relational approaches alleviating the need for restraints.
Since the training began, the severity of employee injuries measured by days away, restricted, or transferred decreased 16%. Staff also reported greater confidence in keeping people safe and collaborating during a restraint.
2. Matching the response to the level of need
Children’s Nebraska created a tiered behavioral escalation prevention and response system to recognize and respond to distress early, prevent behavioral escalation and workplace violence, and support the safety and well-being of patients, families, and team members.
The model includes a social work consultation for children experiencing mild distress or agitation, a collaborative huddle when distress or behaviors begin to interfere with safe care, and an immediate response for severe agitation or an imminent risk of harm.
When the response team arrives, members provide a brief handoff, complete a rapid assessment of safety and support needs, assign roles, and develop a collaborative care plan in partnership with the child, family, and bedside team.
Instead of launching the program across the hospital at once, Children’s Nebraska expanded it by one unit every three months. The phased plan helped the steering group incorporate lessons from each clinical area while improving processes and engaging team members as partners in implementation.
The proportion of team activations through preventive huddles increased from 33% in 2024 to 49% in 2025. Over the same period, the proportion of activations involving restraint use decreased from 22% to 15%.
3. Bringing behavioral health expertise to the bedside
Cook Children’s Medical Center is also seeing an increase of patients exhibiting high-risk behaviors. These patients are often admitted for a primary medical condition and can be admitted to different areas of the hospital. Leaders created a Behavioral Emergency Response Team to support staff during behavioral emergencies and reduce the risk of patient and employee injuries.
The multidisciplinary team includes a behavioral health staff member, security officer, hospitalist, house supervisor, chaplain, and bedside nurse. Team members quickly manage situations through deescalation and medication management, and the team is trained on how to initiate a restraint as a last resort to maintain safety.
Behavioral health technicians also proactively visit children identified as having higher behavioral needs. This relationship-building gives responders a foundation for supporting a child if an escalation occurs later.
Since the team was created in 2022, the hospital has recorded intervals of more than 300 days between serious employee injuries. And staff members say they feel safer and more comfortable caring for kids with high-risk behaviors.
4. Engaging frontline staff in daily planning
Nationwide Children’s Hospital focused its improvement efforts on children associated with repeated interventions or injuries. Of 1,670 unique patients admitted to its behavioral health units, 65 caused an injury. One patient accounted for more than 40% of the hospital’s total OSHA-recordable injuries in that setting.
In response, the hospital centralized its crisis response, standardized critical incident reviews, adjusted staffing based on patient needs, and introduced daily planning for patients at elevated risk.
A daily afternoon touch base brought staff caring for these patients to identify and mitigate unit-specific risks and potential trouble spots.
For kids with more complex concerns, a focused huddle establishes a shared safety and care plan. Frontline employees participate directly in these meetings to provide input on how teams can prevent escalation, recognize triggers, and engage each child.
5. Connecting early screening with continuous improvement
Children’s of Alabama learned from peer hospitals that an emergency response team alone is not enough. The hospital established a Behavioral Event Support Team pathway to proactively identify risks and begin planning when a child is admitted.
Staff ask families whether they have concerns about how their child will cope with hospitalization and whether the child has shown behavior during the previous six months that could harm someone. If the answer is “yes,” the admitting nurse, charge nurse, and physician huddle to discuss triggers and positive reinforcers, make an initial plan, and be assigned to the pathway.
Child life, social work, spiritual care, and other multidisciplinary team members contribute to the care plan. The pathway follows the child through electronic health record banners, care consideration, and visual cues to help staff prepare before entering the room.
Learning continues after an event. Immediate and multidisciplinary debriefs help teams identify trends, agree on changes, and acknowledge what staff members did well.
This work was presented in the “Improving Staff Safety and Reducing Employee Injuries: Case Studies From Behavioral Health” keynote session at CHA’s 2026 pediatric quality conference.
