Transforming the Behavioral Response System

Originally posted March 2022

The Behavioral Response Project is the current effort to design a new and sustainable anti-racist behavioral response system to replace Code Purple. Code Purple is a process to initiate a de-escalation response when other interventions to manage behaviors that put patients, visitors or workforce members at risk for injury or harm are not successful.

The project includes making necessary improvements to the current Code Purple system to reduce harm to patients, families and workforce members. Additionally, relying on an equitable and participatory process called co-design, Seattle Children’s is prioritizing engagement with Black and African American patients and families, a population that is overrepresented in the number of Code Purple calls, to define a new behavioral response system. In the co-design process patients, families, community and workforce members are sharing ideas and decision making and identifying more equitable solutions together.

Quarterly Progress Key Takeaways

The Behavioral Response Project team, comprised of families, community and workforce members, continues their work to transform Seattle Children’s behavioral response system into one that is equitable and anti-racist so that disparities are eliminated. This is accomplished by:

• Improving current Code Purple procedures to decrease harm to patients and workforce members, ensuring that all workforce members who respond to a Code Purple are fully trained and equipped to respond in an equitable manner.
• Relying on an equitable and participatory process called co-design, the project team is working with additional patients, families, community and workforce members to design a new and sustainable anti-racist behavioral response system to replace Code Purple.

Progress to Date

Improvements to current Code Purple

• Hired three additional full-time employees as part of the Behavioral Support Team to ensure around-the-clock support for the Psychiatry and Behavioral Medicine Unit and inpatient units. Trained all 400 Code Purple responders in evidence-based critical behavioral response approaches using the “Safety Cares” program, emphasizing de-escalation from a trauma-informed perspective.
• Drafted a two-stage debrief system in collaboration with the Center for Diversity and Health Equity and the Workforce Inclusion, Diversity, Equity and Inclusion team to continue monitoring and identifying opportunities to improve the use of Code Purple. Next steps include:
  • Gathering and incorporating feedback over a two-month phased rollout before broader system implementation.
  • Testing the debrief tool with the Behavioral Support Team, expecting refinements and broader implementation in the coming months.

Co-designing the new behavioral response system

• Engaged Artefact, an external firm with expertise in co-design, to work with patients, families, community and workforce members to develop a model that enables collaboration with stakeholders in inclusive, trauma-informed workshops to co-create recommendations for a new behavioral response system.
• Recruited approximately 30 participants including patients, families, workforce and community members for discussion group participation. Compensated all participating patients, families, workforce and community members in appreciation of the time and energy involved in the process.
• Experienced anticipated challenges recruiting participants due to community and patient/family hesitancy to relive past trauma. Relied on intentional outreach with a trauma-informed approach, engaged community members who have a relationship with Seattle Children’s, and shifted approach where necessary to foster participant confidence and comfort, while providing opportunities for patients, families, workforce and community members to actively co-design new solutions.