Jessy Warner-Cohen, PhD, MPH, was a year into her job as a health psychologist at Long Island Jewish Medical Center in Queens, New York, when hospital leaders asked if there was anything they could do to help patients prone to outbursts and other behaviors that disrupted their care. These patients had been admitted to a medical hospital, but they also had psychiatric conditions that were difficult for care teams to manage.
Drawing on her expertise in psychology and public health, Warner-Cohen helped design and now co-manages the 25-bed MindFull CARE (Connectedness, Awareness, Respect and Empathy) unit that improves treatment for patients with paranoia, dementia, delirium and other conditions. Her model has proven to be effective: Data show patients are less likely to need restraints while in the unit and more likely to reintegrate into the community after discharge.
"We're also saving the hospital $1 million per year because disruptive patients can come to our unit rather than being placed on constant observation, which is expensive," says Warner-Cohen.
The Monitor talked to Warner-Cohen about her path to the position.
What experience led you to this job?
When I was a clinical psychology graduate student at the University of Maryland, Baltimore County, I decided that I wanted to expand my options for research, so during my fifth year, I enrolled in the master's program in public health at Johns Hopkins University.
After graduating with my clinical psychology degree in 2012, I started a fellowship at Albany Medical Center, where I worked on an integrated-care team. Then I applied for a behavioral cardiology position at Long Island Jewish Medical Center. I didn't get that job, but I had made a good connection with the vice chair of behavioral health during the interview. He told me that with my dual training in psychology and public health I would be an asset to the hospital. He hired me in an interim role working in the inpatient psychiatric unit at the center until he could find the right position for me.
After three months, he asked me to start helping the medical teams scattered throughout the hospital that were struggling to treat patients with mental illness. Patients were refusing to take their antibiotics, screaming at nurses, unwilling to be isolated due to an infectious disease and the like. I worked to de-escalate the patients and trained staff about motivational interviewing and behavioral management. I taught nurses how to use open body language and eye contact to help these patients feel safe, and how to listen and collaborate rather than verbally spar when patients were uncooperative.
A year into that role, the medical and nursing directors of the hospital wanted to know what more we could do for these patients. We came up with the idea of creating a unit to meet their needs, rather than having me run around the hospital to deal with isolated incidents. The hospital asked me to use my program-development skills to design and staff the new unit.
How is this unit unique?
For starters, I co-manage it with a physician and nurse, which is unusual for a medical unit. The staff know the types of factors that can trigger aggressive behavior, like hospital rules about when patients have to take their medication. We can often prevent escalation to verbal or physical violence by giving patients a sense of control, such as by allowing them to choose how they take their medication and keeping them informed about their care.
We also created a position staffed with nursing aides who are trained to form strong bonds with patients by learning everything about them—favorite music, foods, fun activities. The unit also includes certain physical features such as pastel paint colors on the walls, which are more soothing for patients than white. Also, rather than one nursing station, we have stations throughout the unit so nurses can hear their patients and be readily available if someone is escalating.
Because we know our patients are more willing to receive care when they feel comfortable, we also created a common area with recliners, a TV and a special table that can fit wheelchairs. Patients can walk around rather than be confined to their rooms, which is often the case when they are on other medical units. We also keep patients busy with activities like creative art projects and Zumba so they won't get restless.
When patients can't be de-escalated, anti-psychotic medications are also an option.
"People often think of psychologists as very siloed and not necessarily leaders on the medical team, but I've been given the opportunity to be a leader on this unit."
"We're also saving the hospital $1 million per year because disruptive patients can come to our unit rather than being placed on constant observation," says Dr. Jessy Warner-Cohen.
What do you do in a typical day?
We get a lot of challenging patients who come from the state psychiatric hospital, group homes and the streets of northeast Queens, so it's important for me to figure out early who is at risk of exhibiting disruptive behaviors. I screen about 20,000 emergency room patients every year to identify people who would be good candidates for our unit. I'm looking for flags like a previous diagnosis of severe mental illness, developmental delay or dementia, or a history of trouble adapting to the hospital environment. There are certain cases we don't take, such as anyone withdrawing from alcohol or who is suicidal, because those patients need constant observation.
Each day, I do interdisciplinary rounds on the unit with a social worker, case manager, nurse practitioner, physician and nurses to determine if there was any disruptive behavior during the night and to discuss patient treatment plans. Recently, we had one teen who was catatonic due to severe trauma. He wasn't eating, talking or moving. We had to plan how to make him feel safe and supported in the hospital. We made sure he had the same staff nurses as much as possible, and we provided art therapy because he liked coloring. Now, he's starting to speak and eat a little, and he's even started kicking around a soft soccer ball.
What is difficult about your job?
I'm the only psychologist in a medical hospital with 620 beds, so when I face a challenging situation, I can't turn quickly to my colleague and ask what to do. But there are six psychologists throughout the 18 hospitals in the Northwell system [of which Long Island Jewish Medical Center is part] in New York, so I've learned to seek them out when I need a consult.
What about your work would surprise others?
People often think of psychologists as very siloed and not necessarily leaders on the medical team, but I've been given the opportunity to be a leader on this unit. The unit has been so successful that administrators from hospitals around the country are visiting to see if they can replicate the program because they are all struggling with patients diagnosed with both medical and psychiatric illnesses, especially those with dementia. It's really exciting to be part of a creative approach to health care that allows me to work both within a system and outside the box.
