Adolescent Inpatient Unit Research Articles

Nurses' responses to adolescent distress in an acute child and adolescent mental health inpatient unit: A qualitative interpretive descriptive study.

To describe observed nursing responses and interventions to adolescent inpatients experiencing distress. Thorne's interpretive descriptive approach guided data collection and analysis of nonparticipant observations of a purposive sample of adolescents, and nurses. Three major themes are presented: engagement: responses and interventions for working with distress; adolescent reactions and nurses' clinical decision making to manage distress; and outcomes: escalation or resolution of distress. The TAR3 conceptual model developed from this study can guide nurses' responses to distressed adolescents and promote safety, enhance positive outcomes, and reduce the use of coercive interventions.

Comfort Equals Nurturing: Young People Talk About Mental Health Ward Design.

The aim of this research was to obtain user perspectives of adolescent patients to inform the redesign of an adolescent mental health inpatient facility ward unit in regional Australia. It is well established that the consumer will use and understand unit space differently than the health professional, because of their unique positioning and depth of experience. The participation of young people in the design of ward environments and programs is essential. A combination of focus groups and interviews was undertaken with eight participants. This study found that, in its current form, the unit revolves around routines, tasks, and patient safety, which in turn are driven by secure spaces and surveillance of the patients. Due to these routines and tasks, the aspects of individualized patient care and personal impetus and comfort are lost. Adolescent patients are able to identify solutions to enhance their hospital stay in the mental health context without being excessive and unrealistic in their suggestions. When designing an adolescent unit, there needs to be some consideration as to how the group using the unit understands space. Through their role and depth of hospital experience, the adolescent patient will use and understand unit space differently from that of the health professional whose role is a worker. Therefore, it is necessary to gain the perspectives of adolescent patients for efficient and effective functioning of such an environment and to suit the needs of those it is "built for," the adolescent patient.

The experience of parents faced with the admission of their adolescent to a child and adolescent psychiatric inpatient unit. A qualitative study with focus groups

The admission of an adolescent to a child and adolescent psychiatric inpatient unit has a serious impact on the entire family unit. The emotional experience of those primary caregivers has been scarcely studied qualitatively despite being recommended by previous research. This study aims to examine the experience of parents of adolescents with mental health needs that required psychiatric hospitalization in a child and adolescent unit. Qualitative cross-sectional research was carried out under the recommendations of Grounded Theory with three Focus Groups of parents (N = 22) of adolescents who required psychiatric hospitalization in a child and adolescent ward. The COREQ quality criteria were applied. The parental experience implies a high level of emotional suffering modulated by feelings of guilt, stigma, parental awareness of their child’s illness and the passage of time. The use of Prochaska’s and Diclemente’s trans-theoretical model of health behavior change is useful in understanding the parental experience.

A quality improvement project on timely completion of bloods and ECGs on a tier 4 child and adolescent inpatient unit

AimsPhysical health monitoring is paramount to optimal care for psychiatric patients. Blood tests and ECGs are invaluable tests throughout a patient's care. At baseline, they aid investigation of potential organic causes of psychiatric presentations and provide organ and electrolyte status before starting medication. Common psychotropic medications carry physical health risks: bloods and ECGs aid in monitoring potential side effects of prescribed medication.In this local Tier 4 inpatient unit, anecdotal observation revealed completion of these basic investigations was noted to be suboptimal.This project aimed to improve timely completion of baseline (within 72 hours of admission) and monitoring (within one week of due date) bloods and ECGS.MethodThis project was completed within a 12-bed child and adolescent inpatient unit. Using Plan Do Study Act (PDSA) methodology, the multidisciplinary team collated driver diagrams to identify potential areas for intervention. Following baseline analysis, colleague communication was considered key. Consequently, a chart for bloods and ECG completion was created.Each monthly PDSA cycle included the following consecutive interventions: PDSA cycle 1: chart implementationPDSA cycle 2: chart simplification and font size increasePDSA cycle 3: allocated change in team leader for this cyclePDSA cycle 4: Blood request pocket in officePDSA cycle 5: chart simplification through removal of datesPDSA cycle 6: ECG pocketPDSA cycle 7: box on handover listResultMonthly investigations and admission numbers are unpredictable and inconsistent in this cohort: relevant case numbers per PDSA ranged from zero to ten. The results were presented as percentages to allow for direct comparison between cycles.Baseline and results of each consecutive PDSA cycle described above were as follows (N/A represents a cycle where no investigations were required):Admission bloods were completed within 72 hours in 50%, 100%, 50%, 80%, N/A, 100%, 100%, 100%Admission ECG was completed within 72 hours in 30%, 66%, 50%, 70%, N/A, 100%, 100%, 100%Monitoring bloods were completed within one week of due date in 25%, 33%, 0%, 80%, 100%, 100%, 100%, 100%Monitoring ECG was completed within one week of due date in 0%, 0%, N/A, 66%, 100%, 66%, N/A 100%ConclusionThrough close multidisciplinary collaboration and chart implementation, completion of bloods and ECGs improved. Low patient numbers per PDSA cycle resulted in large changes in percentage results, limiting the significance of these findings. Wider implementation of the chart within local Trust inpatient wards is considered.

Has the COVID-19 pandemic affected out-of-hours presentations in CAMHS?

AimsThe aim of this project was to look at whether the COVID-19 pandemic, specifically lockdown, has impacted out-of-hours presentations to Child and Adolescent Mental Health Services (CAMHS) in North Central and East London.MethodSpecialist Registrars (SpRs) on the Royal London/Great Ormond Street CAMHS Higher Training Scheme are contacted for advice regarding all CAMHS presentations in the North Central and East London area. Responsibilities includes provision of advice to 6 hospitals (including 4 emergency departments) and 4 child and adolescent inpatient units. A record of all phone calls and call-outs, including Mental Health Act and Section 136 (S136) assessments are maintained and this study compares pre- and post-COVID-19 data to see if there are any differences in number of presentations, on-site assessments (including Mental Health Act and S136 assessments over 2019 and 2020.ResultNumbers of CAMHS presentations were lower in 2020 (mean 74 patients per month) compared with 2019 (60 patients per month). This was consistent across all months except October and December. The largest difference was seen in March: 109 patients presented in March 2019, compared with 55 in March 2020. This is also reflected in the number of assessments conducted on site. However, there do not appear to be differences in the numbers of Mental Health Act or S136 assessments undertaken over 2020, compared with 2019.ConclusionCAMHS out-of-hours presentations dropped off significantly at the start of the COVID-19 pandemic in the UK, and in particular, with the first lockdown (March to July 2020). Specialist Registrars provided advice via telephone less frequently in 2020 compared with 2019, and were required to do fewer on-site assessments of children and young people presenting with mental health difficulties.There were no significant differences in Mental Health Act or S136 assessments between the two years, however, these numbers are too small to make any meaningful conclusions.It is likely that children and adolescents were less likely to present to emergency departments for assessment of their mental health difficulties during the COVID-19 pandemic, rather than this reflecting a true reduction in mental health difficulties.Recommendations:It is helpful to continue to monitor CAMHS out-of-hour presentations.Trusts may want to consider alternative settings for providing emergency CAMHS assessments, for example, mental health hubs.Limitations:This provision of data is subject to recall bias.

Improving Patient Flow and Access to Care at an Academically Affiliated Urban Safety-Net Hospital.

Access to inpatient psychiatric beds remains a significant barrier to care for patients having a mental health crisis. A quality improvement initiative described here was designed to increase access to care by increasing efficiency of health care delivery on an adult and adolescent inpatient psychiatric unit. Design and implementation centered on collaborative relationships among hospital administration, physician leadership, frontline physicians, and members of the multidisciplinary treatment team. Initial 5 months of data indicated significant improvements in care access as measured by number of encounters on both units. Reductions in length of stay were made possible by optimizing internal work flows and standardizing goals of hospitalization.

Trends in admissions to a child and adolescent neuropsychiatric inpatient unit in the 2007–2017 decade: how contemporary neuropsychiatry is changing in Northwestern Italy

PurposeRising levels of psychopathology in the adolescent population have been evidenced in the last few years throughout the Western world. We aim to examine how contemporary neuropsychiatry is changing in Northwestern Italy and how this impacts inpatient services.MethodsThe present research considered the 1177 admissions to a public neuropsychiatric inpatient service in the 2007–2017 decade. The annual percentual change (APC) was analysed for the total admissions, the number of the neurological vs psychiatric admissions, the length of inpatient stay, and the mean age at admission, also accounting for sex differences. The annual trend was also calculated for each diagnosis.ResultsThe overall number of inpatient admissions decreased significantly (APC = − 5.91), in particular for children under 12 years of age (APC = − 7.23). The rate of neurologic diagnoses significantly decreased (APC = − 26.44), while the length of the inpatient stay (APC = 6.98) and the mean age at admission (APC = 6.69) increased. Among the psychiatric diagnoses, depression significantly rose (APC = 41.89), in particular among female adolescents (APC = 40.30).ConclusionsThese data document a substantial change in the utilization of inpatient neuropsychiatric services for children and adolescents, with a major increase in psychiatric hospitalizations and a parallel decrease in neurological ones. These trends call for greater attention to early preventive intervention in mental healthcare system.

Borderline Personality Traits and Emotion Regulation Strategies in Adolescents: The Role of Implicit Theories

Borderline Personality Disorder (BPD) is associated with emotion dysregulation. The emotion regulation strategies people adopt may depend on one’s belief about emotion as either fixed or changeable (termed “implicit theory”). We test this experimentally by modifying beliefs about emotions using virtual reality (VR). A sample of 29 adolescents (ages 14–17 years) were recruited from two adolescent inpatient units for an uncontrolled pilot trial of a new brief intervention. We measured BPD traits, beliefs about emotion, treatment preference, cognitive reappraisal and rumination, before the VR game and 14–31 days later. Adolescents with higher levels of BPD traits endorsed fixed beliefs of emotion and reported higher levels of rumination and lower levels of cognitive reappraisal. After a one-time message delivered via VR, adolescents evidenced an increase in belief that their emotions were changeable. These findings suggest beliefs about emotions may have an important role in interventions for adolescents with BPD traits.

Debate: Inpatient units must enhance the system of care.

Child or adolescent psychiatric inpatient units are expensive; therefore, a lot is expected of them. Short stay units are best used for diagnostic clarification, the initiation and supervision of complex treatment, and acute containment of risk. Longer stay units provide a recovery-focused programme to address mental health problems that have not responded to intensive treatment in other settings. Both types of unit form part of the wider system of care that supports young people with mental health problems. The operational characteristics of such units will ensure timely, safe and effective interventions to young people who will likely go on to receive most of their clinical care in the community.

Demand Analysis of a Psychiatric Emergency Room and an Adolescent Acute Inpatient Unit in the Context of the COVID-19 Pandemic in Madrid, Spain.

Introduction: COVID-19 represents a serious threat to mental health worldwide. The aim of this study is to identify changes in adolescent psychiatry treatment demand in a tertiary hospital in Madrid during the first month (March 11 to April 11) after the pandemic declaration by the World Health Organization (WHO). We hypothesized that fear of contagion within COVID-19 may deter people from asking for psychiatric care.Method: The current study is retrospective, observational, and transversal. We reviewed the clinical records of 89 adolescents who went to the Emergency Room (ER) or were hospitalized at the Acute Inpatient Unit (AIU) at the Puerta de Hierro University Hospital-Majadahonda (PHUH-M) between March 11 and April 11. Socio-demographic, clinical, and demand variables were included in the study. Chi-square or Fisher exact tests were performed to compare categorical variables. We used the U Mann-Whitney test to compare quantitative variables. The level of statistical significance was set at p< 0.05. Analyses were conducted using SPSS v11.0.Results: The number of adolescents demanding psychiatric care at the ER dropped from 64 adolescents in 2019 to 25 in 2020. Similarly, psychiatric demand collapsed from 31 to 18 patients when comparing 2019 and 2020. Furthermore, the average hospital stay in 2020 trended toward a decrease when compared to 2019 (8.94 ± 4.87 vs. 14.32 ±10.23, p = 0.08). Self-injurious thoughts and behaviors were the most predominant reasons for consultation at both ER and AIU.Conclusion: The demand for adolescent psychiatric care decreased in the first month after the declaration of the pandemic. Our findings may be explained by (1) the fear of contagion, (2) the strict confinement measures, and (3) the initial shock as an adaptive reaction described in other disasters. Further studies are needed.

Suicidal Mental Imagery in Psychiatrically Hospitalized Adolescents.

Suicide is the second leading cause of death in adolescents and suicide rates in this population have increased in recent years. A critical step in preventing suicide is improving the accuracy of suicide risk assessment. Measurement of suicidal cognitions typically emphasizes assessment of verbal thoughts about suicide. Recent research suggests, however, that suicidal mental imagery, or mentally imagining suicide-related content, may be even more strongly associated with suicidal behavior. No research has evaluated suicidal mental imagery in adolescents, however. The present study evaluated suicidal mental imagery and suicidal verbal thoughts in a sample of adolescents (N = 159) admitted to an adolescent psychiatric inpatient unit. Of those adolescents who reported suicidal cognitions, 63.73% reported suicidal mental imagery. Adolescents who reported suicidal mental imagery had 2.40 greater odds of having made a suicide attempt, after accounting for history of suicidal verbal thoughts and relevant covariates. Findings suggest that suicidal mental imagery should be directly assessed when evaluating suicide risk, and that treatments may be optimized by targeting both suicidal verbal thoughts and suicidal mental imagery.

Nurse and patient factors: Predicting seclusion in adolescent psychiatric units.

Seclusion is considered a necessity when alternatives have failed. There is a consensus that seclusion has no therapeutic benefit, which justifies efforts to reduce the practice. This study aimed to identify nurse and patient variables that are predictive of seclusion on a large adolescent inpatient unit. Nested case controls were used to compare 72 afternoon shifts on which seclusion occurred to 216 afternoon shifts on which no seclusion occurred, between 2010 and 2013, at an Adolescent Psychiatric Inpatient Unit. Increased seclusion was predicted by a lower nurse to patient ratio, more male nurses on shift, fewer female nurses on shift, the presence of agency/temporary nurses on shift, greater combined years of mental health experience, and lower total HoNOSCA behavior subscale score. Unique predictors that increased risk of seclusion included greater number of male nurses and the presence of agency/temporary nurses, while a greater number of female nurses decreased risk of seclusion. Nurses play a unique role in seclusion outcomes that are separate to patient-factors and act as both protective and risk factors for seclusion. Changes can be made to staffing to reduce seclusion and future research should investigate why these nurse-factors contribute to seclusion.

Pakistan's First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period.

Background & Objective:Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit.Methods:Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed.Results:Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3 ± 2.3. Mean duration of admission was 15.60 ± 6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge.Conclusion:Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries.

An Appreciation of Tony Kris

An Appreciation of Tony Kris James P. Frosch (bio) It didn't have to turn out this way. A young man born to the psychoanalytic manor, so to speak, could have developed into a not so young man who elevated himself above others and dedicated himself to the preservation of orthodoxy and the enhancement of his power. Instead, somehow, we have quite the opposite: a man who has lived a life of generosity, a life of personal and professional growth based on a fearless soul-searching of himself, a life of love and generativity. Love of the intellectual, love of the sensual, love of loving. The somehow of how people develop into who they are is always something of a mystery, and so it is with Tony. Somehow, he evolved into someone who embodies the Aristotelian virtue of balance. Balance between respect for tradition and appreciating the necessity for radical innovation. Balance between a healthy regard for self, and a capacity to admire and sacrifice for others. Balance between providing a place for the passions, but also for temperance and reason. In response to a question about who were Tony's major influences, he wrote the following in an email: "There were so many influences. Anna Freud and my father were my best teachers, but my mother's way with patients was probably even more influential. Semrad added a depth that I have aimed to achieve. Jocke Murray helped me understand my own narcissism, though my formulations were different from his. The work with psychotic adolescents drew my attention to ambivalence." A glance at Tony's CV reveals a broad range of experiences. Notable were training at Mass Mental Health Center in its heyday, directing a unit at the old Boston State Hospital dedicated to the treatment of psychotic adolescents, and a two-year stint doing empirical research in the department of neuroendocrinology at the Walter Reed Institute of Research while in the Army Reserves (yes, you can accurately call him Captain Kris). In addition to the influential psychoanalytic papers which we all [End Page 703] know, there were early papers that make for fascinating reading, such as one on the function of a library on an inpatient adolescent unit, and a prescient paper on combining behavior therapy with psychodynamic therapy in a State Hospital setting. Experiences are never lost, they either remain dissociated and sequestered or, as in Tony's case, become integrated into a whole that grasps complexity. It may be that Tony's experience doing laboratory research strengthened his belief that theory must never take precedence over observation. I first met Tony during my candidacy, which began in 1978. He was already a legendary and hard-to-get supervisor, and I joined the waitlist. Finally, he had time to supervise my third case (by this time we are in the early 1980s). Tony was in his early forties then and had already had a heart attack. His father had died of an MI in his fifties. Tony was about to have a coronary artery bypass surgery; I can't remember whether triple or quadruple. I think Tony never expected to live as long as he has. Though not uncaring of other people, I was an ambitious young man in a hurry. I had a bunch of potential analytic cases in my practice, and I wanted to be approved to see my third case and do unsupervised work at the same time. I needed a letter from Tony. So I had a lot of different thoughts. I was already developing a love for Tony and was worried about him. I also worried he would die on the operating table before writing the letter I needed. All of a sudden, Tony looked at me with affection and no judgment and started laughing. He said, "I'll write the letter before the operation." I don't know how he read my mind, probably through his extraordinary ability to put himself in the mind and situation of the other. But what really struck me was the non-judgmental acceptance of my self-interested thought and his genuine amusement about it, not to mention his existential courage in facing the possibility of...

Phenotypic Characterization of Youth Admitted To Acute Psychiatric Inpatient Unit Following Self-Harm Behavior

Objective Deliberate self-harm (DSH) is a major health concern among adolescents, and is often associated with the need for inpatient psychiatric hospitalization. The aim of this study was to identify clinical and demographic characteristics associated with DSH behavior among adolescents admitted to an acute psychiatric inpatient unit. Method We retrospectively analyzed data from the electronic medical records of consecutive admittances to a single acute adolescent inpatient unit (n = 703, mean age 15.2). We compared inpatients with DSH to inpatients without DSH and further compared within the DSH group based on the presence of suicidal intent. Results Compared to Non-DSH inpatients (n = 497), youths admitted following DSH (n = 206) were more likely to be female (OR = 2.6, 95%CI 1.7–4), currently in depressive exacerbation (OR = 2.4, 95%CI 1.6–3.6), with concurrent suicidal ideation (OR = 3.9, 95%CI 2.5–5.9), and history of alcohol use (OR = 5.6, 95%CI 3.2–9.5). Within DSH youths, no significant clinical differences were identified between those admitted following a suicide attempt (n = 102) compared to non-suicidal-self-injury (n = 104), who were generally younger. Conclusions Findings suggest that early detection and intervention of DSH and depressive crisis is warranted, regardless of the self-harm subtype. HIGHLIGHTS Deliberate self-harm is common among adolescent psychiatric inpatients. Adolescent inpatients with deliberate self-harm are predominantly females with concurrent depression and suicidal ideation. We did not detect significant clinical and demographic differences between self-harmers with or without suicidal intent.

Missing the forest for the trees? A high rate of motor and language impairments in Disruptive Mood Dysregulation Disorder in a chart review of inpatient adolescents.

Youths with severe and persistent irritability have a particularly high rate of school failures and learning difficulties. The aim of this study was to determine whether inpatient adolescents with Disruptive Mood Dysregulation Disorder (DMDD) have more motor and/or language impairments compared to patients with other psychiatric disorders. A retrospective chart review of all consecutive cases admitted in two adolescent inpatient units between January 2017 and December 2018 was conducted (N = 191). All patients received multi-disciplinary clinical and developmental assessments. For a subtest of subjects, additional standardized tests were used to document motor and language impairments. In this clinical chart 53 adolescents with a DMDD (mean age 13.6 ± 1.5, min 12, max 16, 70% males) were compared to patients with a major depressive disorder (MDD, n = 64, mean age 15.3 ± 1.6, 52% males) and patients with a non-mood disorder (NMD, n = 61, mean age 14.4 ± 1.55, 59% males). Among inpatients with DMDD, 71% had an associated motor and/or language disorder, with combined forms in around two-thirds of cases. Compared to youths with MDD, participants with DMDD were more likely to have an associated developmental coordination disorder (67% vs. 22%, OR = 4.7) and a written language disorder (35% vs. 10%, OR = 4.6). While 31% of inpatients with DMDD had an associated communication/oral language disorder, this rate was not statistically different from those observed in the MDD group (11%, OR = 3.2). The frequencies of motor and language impairments were not statistically different between participants in the DMDD group and in the NMD group. The high rate of motor and written language disorders found in DMDD patients may partly account for their academic difficulties. Such finding, if confirmed, supports systematic screening of motor and written language impairments in youths with chronic irritability and suggests remediation potential.

The Diagnoses and Sociodemographic Characteristics of Children and Adolescents Treated in a University Hospital Psychiatry Inpatient Service

Background: The purpose of this study was to perform a retrospective file examination of the sociodemographic characteristics, symptoms leading to admission, length of stay in the inpatient unit, diagnoses, and psychotropic drugs used by children and adolescents who were treated in the psychiatric inpatient unit.Materials and Methods: The records of patients aged under 18 (n=85) receiving treatment on an inpatient basis at the Harran University Medical Faculty Psychiatry Department inpatient unit between 1 August, 2016, and 1 September, 2018, were screened retrospectively. Case data were assessed using a data form produced by the author in terms of age, sex, parental ages, symptoms resulting in admission, diagnoses received, length of hospitalization, presence of multiple hospitalizations, and psychotropic drug use. Case diagnoses were based on clinical interviews using Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria. SPSS 23.0 software (SPSS Inc., Chicago, USA) was used for statistical analysis. Statistical significance was defined as p&amp;lt;0.05.Results: Fifty-six of the patients included in the study were female and 29 were male. Major depressive disorder was the most frequent diagnosis among the patients (n: 30, 35.3%). The mean duration of hospitalization was 20.6±19.6 days. Eighty-five (100%) of the 85 patients had used one psychotropic agent during treatment. Antipsychotics were the most preferred drug group in our study (87.6%).Conclusions: Mood disorders constituted the most common reason for hospitalization. Psychotropics were used by all patients during hospitalization. Schizophreniform disorder and substance-related disorders were significantly higher in boys, while rates of conduct disorder and borderline personality disorder were significantly higher in girls. Since child and adolescent in-patient units are not available in all provinces, in clinical practice treatment is administered on an inpatient basis in adult psychiatric units. It is important for patients to be followed-up by child and adolescent psychiatry specialists in terms of being treated under emergency conditions without having to wait in line for treatment by being hospitalized in adult psychiatric units in places where there are no in-patient ünits for children and adolescents.

Prevalence and clinical indices of risk for sexual and gender minority youth in an adolescent inpatient sample

ObjectiveRates of self-injurious thoughts and behaviors have increased in adolescents over the past two decades. Sexual and gender minority (SGM) youth report elevated rates of self-injurious thoughts and behaviors compared to heterosexual and cisgender youth. Studies of factors influencing suicide risk in SGM youth remain limited, however, and have largely been conducted in community or epidemiological samples. MethodThe present study aimed to address these limitations by examining the prevalence and clinical characteristics of sexual and gender minority youth in a sample of 515 youth admitted to an adolescent inpatient unit. In addition, the present study aimed to compare rates of self-reported self-injurious thoughts and behaviors, adverse early childhood experiences, and rates of rehospitalization in sexual and gender minority compared to non-sexual and gender minority youth. ResultsResults show that nearly 40% of the sample identified as sexual and/or gender minority. Sexual minority youth reported higher rates of suicidal ideation (t = −6.19, p < .001), higher rates of prior suicidal behavior (Chi2 = 27.44, p < .001) and non-suicidal self-injury (Chi2 = 48.09, p < .001), and greater numbers of adverse childhood experiences (t = −3.99, p < .001); gender minority youth reported higher rates of suicidal ideation (t = −3.91 p = .001). There were no group differences for SGM youth in rates of rehospitalization in the 6-months following initial admission. These results held when controlling for sex assigned at birth and current depression status in multi-variate analyses. ConclusionsThe study illuminates the importance of assessing SGM status in clinical care and highlights the need to evaluate sexual and gender minority specific risk factors for self-injurious thoughts and behaviors in youth.

Establishing a Collaborative Care CBT Milieu in Adolescent Inpatient Units

On average, psychotherapy delivered on inpatient units produces clinical outcomes with smaller effect sizes than the same treatments in outpatient settings. The Collaborative Care CBT Milieu presents opportunities to extend the benefits of the therapeutic milieu by capitalizing on paraprofessionals who have the most interactions with patients. Mental health technicians (n = 27) were trained to use CBT strategies in daily interactions with patients on an adolescent inpatient unit. Communication about individualized CBT conceptualization and strategies were integrated into the functions of the unit across disciplines and shifts. Compared to rates of use in the year prior to training, use of physical holds was reduced by 21.25% and use of mechanical restraints was reduced by 43.98%. The Collaborative Care CBT Milieu model demonstrates the feasibility of training MHTs to work in coordination with CBT therapists and other treatment team members to provide milieu interactions consistent with traditional CBT. Training staff to apply CBT theory and strategies within their scope of practice offers a pathway to an inpatient unit with a common language, shared lens for understanding patients, and unified approach to individualized care. Further research is needed to understand how these innovations impact clinical outcomes.

Physical health interventions on adolescent mental health inpatient units: A systematic review and call to action.

Physical health inequalities experienced by people with mental health conditions are labelled an international scandal; due to the 15 to 30-year gap in life expectancy, driven mostly by physical health conditions. Lifestyle interventions are recommended to prevent the onset of poor physical health in people with mental illness. Yet, there is less high-quality evidence for adolescents, particularly those in inpatient settings. We aimed to assess existing literature reporting physical health or lifestyle interventions conducted on adolescent mental health inpatient units. An electronic search of MEDLINE, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials and AMED was conducted on 13th June 2019. Eligible studies included peer-reviewed English language research articles of physical health interventions delivered within child and adolescent mental health inpatient services. A narrative synthesis was conducted on the data. Only three studies were identified implementing health interventions for adolescent inpatients. The interventions consisted of two physical health interventions aiming to increase activity levels within routine care (one gym-based, one sports led) and a yoga intervention. Outcome measurements varied and benefits were observed in relation to overall health (HONOSCA), physical health (waist, hip and chest circumference) and behaviour. Although preliminary results suggest lifestyle interventions may be feasible and beneficial for this group, more work is needed to fully understand the best way to implement these interventions within adolescent clinical settings. Adolescent inpatients are an important target for such interventions, affording the opportunity to prevent the onset of physical comorbidities.