Debriefing Tool Enhances Acute Child and Adolescent Mental Health Care

Understanding the Importance of Debriefing in Acute Mental Health Settings

Acute Mental Health Inpatient Units in Children’s Hospitals represent the location of the most frequent and severe patient behavioural events (PBEs). These events can have a detrimental impact on both patients and staff, leading to increased lengths of stay, poor discharge prognoses, burnout, and high turnover rates for healthcare workers.

With the demand on paediatric mental health services increasing significantly in recent years, both in Canada and abroad, there is an urgent need to support the wellbeing of frontline mental health staff. One effective tool for improving patient safety and supporting healthcare workers in stressful environments is post-event staff debriefing.

Debriefing has been studied in various healthcare settings, such as the emergency room and paediatric intensive care units, showing promising results. Up to 90% of respondents in certain publications have highlighted the psychological benefits and improved emotional resiliency that result from implementing debriefing. Debriefing has also been linked to improved patient outcomes, with studies showing increased survival rates following cardiac arrest resuscitation in paediatric intensive care.

Considering the similarities between PBEs and other acute deteriorations in patient health, researchers at a leading children’s hospital explored the utility of post-PBE debriefing among staff in their Child and Adolescent Mental Health Units (CAMHU). The goal was to assess the impact of debriefing on the rate and severity of PBEs, as well as its impact on staff well-being.

Implementing the TALK Debriefing Tool in CAMHUs

The researchers implemented post-PBE staff debriefing using the TALK tool, a standardised clinical tool designed to facilitate team self-debriefs and promote a culture of learning and patient safety. The TALK framework involves the following steps:

Target: Select a target for discussion, which in this case is centred on a pre-agreed trigger – the PBE.
Analyse: Analyse the care provided for the PBE in terms of what went well and what could be improved.
Learn: Distill the analysis into learning points to be carried forward by the team.
Keep: Identify key actions which serve to maintain or improve patient safety, and delegate responsibility among the team to ensure appropriate follow-up.

The implementation and training of staff in debriefing were facilitated by the unit’s child and youth counsellors, clinical manager, and quality improvement champions. Debriefs were initiated at the request of staff to ensure they were supportive and not burdensome.

Assessing the Impact of Debriefing

The researchers tracked both the monthly rate and severity of PBEs (defined as the proportion of events either bringing harm or nearly bringing harm to patients or staff) as primary measures. As a secondary measure, they collected verbal feedback on debriefing from CAMHU members, comprising registered nurses, through informal conversations with quality improvement champions.

The Findings: Debriefing’s Impact on Rates, Severity, and Staff Perception

Interestingly, the researchers did not observe a significant decrease in the rate or severity of PBEs following the implementation of debriefing. However, the verbal feedback from CAMHU staff highlighted some promising psychological benefits:

Some staff were not familiar with the TALK tool as they had not yet had the chance to use it, but were aware of its existence.
Others who had previously used the TALK tool gave positive feedback, stating that it was “a good tool to get the conversation going” and “helpful to open the conversation and teach staff about vicarious trauma.”
Staff also noted that debriefing has contributed to an overall positive team dynamic, including all disciplines.
From a patient perspective, staff highlighted that debriefing allows for a deeper understanding of the perspectives of all stakeholders in adverse events. It has helped delineate the rationale behind decisions that have contributed to critical incidents, such as restraints.
Debriefing has also provided a venue for patient concerns regarding care plans to be raised by staff, addressed, and reflected in updated care plans.

Limitations and Future Directions

The researchers identified several limitations within their project that future work should aim to address:

Qualitative Feedback Limitations: The results are limited to the local, informal, and non-standardized feedback provided by a small number of CAMHU staff. To address this, the centre is pursuing a strategy of longitudinally administering a well-being survey to quantifiably assess staff burnout before and after implementation of debriefing.
Lack of Patient-Centred Approach: Initial data failed to demonstrate a link between debriefing and improvement in PBE rate or severity. This may be because interventions that successfully reduce PBE rates, such as dialectical behavioural therapy or positive behavioural interventions and supports, are heavily based on patient engagement. Future studies should explore the effects of patient-centred debriefing.
Inconsistent Access to Debriefing: During periods of inpatient surges, fewer debriefing sessions occurred due to demanding workloads and limited access to support. To address this, the centre has introduced quality improvement champions to promote sustainability and remind staff of the availability of debriefing.

By addressing these limitations and exploring future research directions, the researchers aim to enhance their understanding of the impact of post-PBE debriefing on reducing burnout and improving the well-being of staff in acute CAMHUs.

The Way Forward: Debriefing as a Tool for Enhancing Staff Wellbeing and Patient Safety

While the quantitative data did not show a reduction in PBE rate or severity, the qualitative feedback suggests promising psychological benefits for staff, as well as indirect benefits for patients, through improved communication and understanding. Postevent debriefing using the TALK tool has been recognised as a Leading Practice by the Health Standards Organization, demonstrating its potential to enhance staff well-being in CAMHUs.

Future research should focus on quantifying the impact of debriefing on staff burnout, exploring patient-centred debriefing interventions, and developing strategies to ensure consistent access to debriefing support. By incorporating standardised debriefing tools into their practices, healthcare centres can proactively address the psychological impact of patient events on staff, enhance well-being, and potentially reduce burnout among their healthcare professionals. This approach not only supports the mental health of staff members but also contributes to the overall quality of care provided to child and adolescent patients.

To learn more about the efforts to support the mental health and wellbeing of staff at Stanley Park High School, please visit our website.