Building Resilient BIT/CARE Teams: The Work Has to Be Sustainable

Brian and I recently presented an InterACTT webinar on building resilient BIT/CARE teams. We talked about workload, role clarity, burnout, team culture, and what happens to teams after they have been doing this work together for a while. Those aren't necessarily the topics that get people excited about joining a BIT/CARE team, but they have quite a bit to do with whether the team is still functioning well a few years later.

I have always been a little cautious about the word resilience because it can turn into a conversation about how individuals should get better at tolerating difficult circumstances. This work certainly has a personal side. Some cases are hard, some stay with you, and people need ways to take care of themselves. But if the same two people carry most of the difficult cases, nobody knows who is responsible for follow-up, and team members are afraid to say they have too much on their plates, another presentation about self-care won't fix the problem. Sometimes we need to stop looking exclusively at how individual members are coping and take a harder look at the team itself.

What's Going Well? What Could Be Better? What's on Fire?

We used three questions during the webinar that I think are worth stealing for a team meeting: What's going well? What could be better? What's on fire? You could probably learn quite a bit about a team from 20 minutes spent on those questions, particularly if people feel comfortable answering them candidly. A team might be very good at assessing cases but inconsistent about follow-up. Members may genuinely enjoy working together while having completely different ideas about who owns particular responsibilities. Someone may have gradually become the person who handles most of the difficult cases because they happen to be good at them. Being good at difficult work has an unfortunate tendency to earn you more difficult work.

I also think we need to ask what's going well because BIT/CARE teams spend an enormous amount of time talking about what's wrong. That's built into the work. A student is struggling, something concerning has happened, or a situation needs attention, so we put it on the agenda. Eventually the case closes or disappears from the agenda, and we move on to the next one. When we can, it is worth bringing some of those stories back. The student who stayed enrolled, reconnected with support, repaired a relationship, or simply got through a terrible semester is part of the team's work too.

Obviously, we need to be thoughtful about confidentiality when we do that, but people doing difficult work need occasional reminders that a closed case in the database may represent something considerably more important in somebody's life. It also gives the team a chance to see the results of work that can otherwise feel like an endless stream of concerns arriving on the agenda.

Who Actually Owns This?

There is a particular moment in BIT/CARE meetings that I suspect most people who have served on a team will recognize. The team discusses a case, everyone agrees on what should happen next, and then there is a brief pause while everyone waits to see who will do it. Sometimes the answer is obvious, but often it isn't. Who contacts the student? Who talks with the faculty member? Who checks whether the student followed through with counseling? Who documents the decision? Who follows up next week? Who owns the case when it touches three different departments but doesn't really belong to any one of them?

If teams don't answer those questions intentionally, they tend to answer them informally. The dependable people volunteer. The person with the right professional background takes another case. Someone does something because they did it last time and, six months later, it has somehow become their job. That arrangement can work for quite a while because the work keeps getting done. There's no obvious reason to examine the system until somebody burns out, leaves the institution, or finally asks why they are doing all of it.

This is also where I think teams need to periodically look at their scope. What does the BIT/CARE team actually need to own? What belongs somewhere else? What has the team gradually accumulated because nobody else knew where to put it? CARE teams can easily become institutional junk drawers. If something involves a student and nobody knows quite what to do with it, send it to CARE. Some of those cases absolutely belong there, while others probably have an existing home somewhere else on campus. Asking a team already dealing with complicated students to absorb every ambiguous problem isn't sustainable.

The Meeting Isn't the Workload

Workload can be surprisingly hard to see on a multidisciplinary team because everyone sees the case at the meeting. What they don't necessarily see is everything that happens after the meeting ends. A ten-minute case discussion can produce several hours of work for one person. Someone contacts the student, calls a parent, talks with faculty, checks records, consults another office, coordinates services, documents the work, and gets the case ready to return to the team. Meanwhile, everyone else remembers the ten-minute discussion.

Making some of that invisible work visible can change the team's understanding of capacity. It can also expose patterns that have become so routine nobody thinks about them anymore. One person may be getting most of the high-intensity cases. Another may always handle family communication. The clinician on the team may become the automatic choice whenever suicide enters the conversation, even when much of the follow-up isn't actually clinical.

There may be good reasons for some of those patterns. Expertise matters, and I don't think workload needs to be distributed with mathematical precision just to make a chart look fair. There is a difference, though, between intentionally using someone's expertise and quietly building a system that depends on one person always being willing to take the hardest thing. For some responsibilities, rotation may help. It gives more people experience, distributes some of the emotional load, and makes the team less vulnerable when a key member leaves or simply needs someone else to take the next one.

The People Who Always Step Up

Most good BIT/CARE teams have a few people who will step up whenever something needs to be done. You want those people around the table, but I have also watched organizations become remarkably comfortable depending on them. Some team cultures make being overwhelmed look like evidence of commitment. People answer messages at all hours, take one more case, skip the debrief, and keep moving because students need help and somebody has to do it. From the institution's perspective, the system appears to be working because the work keeps getting done.

The problem becomes visible when one of the people holding the system together decides they don't want to do it anymore. A resilient team should be able to hear someone say, "I don't have the capacity for this case right now," without treating it as a lack of commitment. It should also be possible to acknowledge that a case hit someone harder than expected. We work with suicide, violence, trauma, loss, frightening behavior, angry families, and students whose situations sometimes resemble things happening in our own lives. Professional experience doesn't make people immune to any of that, so teams need enough trust to talk about capacity before somebody reaches the point where everyone else can see it.

What Would Make This 10 Percent Easier?

Toward the end of the webinar, we asked another question that I like because it doesn't require anyone to redesign the entire BIT/CARE operation: What would make your work on this team 10 percent less stressful? Ten percent seems doable, and the answers are often surprisingly ordinary. Maybe reports need to reach team members earlier. Maybe somebody needs to clarify who owns follow-up. A section of the meeting has grown unnecessarily long. The referral form creates more work than it saves. One responsibility needs to rotate. People keep leaving meetings without being entirely sure what they agreed to do.

Fixing one of those things won't transform the team, but it might make Tuesday afternoon a little easier. Then you can find the next thing. I think that is closer to how team resilience actually develops. There usually isn't a retreat where everybody discovers the secret to sustainable BIT/CARE work. Teams get better because they notice friction, talk about it, make an adjustment, see whether it helps, and eventually notice something else. What creates unnecessary stress in September may be completely different from the answer in February, which is a good reason to keep asking the question.

Keeping Good People Doing Difficult Work

BIT/CARE work will remain difficult. Some cases are complicated because people are complicated, and no meeting structure or workload spreadsheet will change that. Some cases will also stay with team members long after everyone has stopped talking about them in meetings. We do have some control over the conditions in which people do that work, though. We can clarify roles before confusion becomes resentment, pay attention when difficult work repeatedly lands on the same people, give team members room to talk about capacity, and periodically ask whether the team is doing work that actually belongs somewhere else.

We can also remember to talk about the students for whom something went right. None of this requires rebuilding the team from scratch, but it does require occasionally looking away from the cases long enough to look at the people handling them. If your team hasn't done that lately, those two questions from the webinar aren't a bad place to begin. Ask what's going well, what could be better, and what's on fire. Then ask what would make the work 10 percent easier. You may find something you can actually change.

InterACTT members can access the full webinar video and PowerPoint presentation through our site. If this kind of conversation would be useful to your team, we'd also love to have you join us for an upcoming InterACTT webinar. You can see what's coming next and register at https://www.interactt.org/webinars.