Riley to open Indiana's first pediatric medical-behavioral health unit

By: Courtney Finafrock, Riley Children's Health videographer, cfinafrock@iuhealth.org

A new Pediatric Medical-Behavioral Health Unit is just weeks away from opening at Riley Hospital for Children. The specialized unit is the first of its kind in Indiana and among the first in the nation.

"This is such a monumental moment for Riley," David Biggerstaff, President & CEO of Riley Children's Health, said. "The mental health crisis with our kids today, with adolescents today, has been called the crisis of our era. It's an important part of what we do here at Riley is caring for kids on an outpatient basis, an inpatient basis, and importantly for kids who have these medical needs, and the mental health needs. This is an essential unit for those kids."

The 11-bed Pediatric Medical-Behavioral Health Unit is expected to serve around 325 patients annually who meet certain medical and psychiatric needs. It is designed for children whose complex conditions need additional management beyond a traditional medical or psychiatric inpatient unit. The unit will provide integrated care through a specialized interdisciplinary team that includes specialized dually boarded pediatrician/child and adolescent psychiatrists, psychologists, nurses, therapists, social workers, and other behavioral health specialists. The unit’s design and staffing model have been developed to enhance patient and staff safety while supporting earlier stabilization, better discharge planning, and reduced repeat hospitalizations.

“Our goal is to provide comprehensive care for the whole child,” said Dr. Mara Nitu, chief medical officer of Riley Children’s Health. “Children with co-occurring medical and behavioral health conditions often face delays in treatment because there are few places equipped to manage both needs simultaneously. This unit helps address that challenge by creating a therapeutic environment where medical and behavioral health teams work side by side to deliver coordinated, evidence-based care.”

Patients receiving care on the unit may need treatment for eating disorders, catatonia, encephalitis, anxiety, depression, and other psychiatric conditions that occur alongside significant medical needs.

"You have to have both emergencies occurring together," Dr. Leslie Hulvershorn, head of child psychiatry and behavioral sciences at Riley Children’s Health, explained. "The need for acute hospitalization in both medical and psychiatric. It's very hard to care for patients medically who have a psychiatric emergency, but you're in a medical space because of the way those spaces are built. So, this gives the staff a lot more freedom to be able to say, 'You can take a shower and we don't have to be right there with you because we're confident that the space will allow you to be safe.' Whereas otherwise you'd have to have a staff member sort of watching constantly."

The unit is designed with patient staff and safety at the forefront.

"For example, here we have a shower that's called an anti-ligature shower meaning you can't hang anything on this," Dr. Hulvershorn said as she pointed to the showerhead. "There's really no way to hurt yourself on this shower, and every square inch from the light bulbs to the doorknobs in this new medical-behavioral space is designed so that psychiatric emergencies can occur in this space, yet people can stay safe."

Dr. Hulvershorn emphasized the dual purpose of the space, making it safe for patients with both complex medical and psychiatric needs.

"You might need oxygen tanks and suction and things like that to care for patients with medical emergencies or acute medical needs and those exist in this space but they're kept secure behind [a glass door], so they can be both psychiatric safe and useable," Dr. Hulvershorn said.

The staff believes this will decrease the need for 1:1 staffing because of the safety measures put in place. This means pediatric patients will be able to utilize common areas, which is not typical when they are admitted to a traditional medical floor.

"This is where the kids will spend their free time, the tables; it's where they'll eat their breakfast, lunch and dinner, if they're able to," Rachael Fisher, Administrative Director-Behavioral Health and Integrated Care Management, said. "We have the chairs; they'll play games out here. We have the TV again that's safe. We have a couple of phones built into our unit, so the kids are able to get in touch with parents, guardians, other support such as DCS. It allows our unit to be safe. Having this area where the kids can relax, do group programming, and play games, is just important for their healing."

The new unit builds on Riley’s pediatric behavioral health network, which includes outpatient psychiatric clinics, integrated behavioral health services in primary and specialty care practices, the Be Happy Child Psychiatry Access Program, the Behavioral Health Access Center in the Riley Emergency Department, the Charis Center for Eating Disorders, the Simon Skjodt Child and Adolescent Behavioral Health Unit, and other specialized services throughout the state.

"Importantly, this is an expansion," Biggerstaff said. "So we are not eliminating beds anywhere else, we're just fortunate to be able to add these beds."

The unit was made possible by generous donor support to Riley Children’s Foundation as part of the Every Child Deserves Riley campaign, which identified pediatric behavioral health as a key priority for Indiana’s children.

“This unit is a powerful example of what is possible when a community comes together to invest in children’s health,” said Courtney Roberts, president of Riley Children’s Foundation. “Our donors recognized the urgent and growing need for expanded pediatric behavioral health services. Their support helped create a welcoming, innovative space where children and families can receive the specialized care they deserve during some of their most challenging moments.”

Studies show nearly 300,000 Indiana youth experience a mental health condition each year, while suicide remains the second-leading cause of death among Indiana adolescents and young adults. Riley’s leaders hope the unit will reduce emergency department use, support families, and create better long-term outcomes for children facing complex medical and behavioral health challenges.