Adolescent Psychiatric Inpatient Unit Research Articles

Surveying Child and Adolescent Inpatient Psychiatric Units: Demographics, Policies, and Practice

ABSTRACT Background The increasing demand for acute inpatient psychiatric unit (IPU) treatment for children and adolescents in recent years has put significant pressure on hospital systems to provide efficient and effective care. However, there is a gap in the literature regarding the characteristics of IPU care for children and adolescents in the US, making it difficult for institutions to benchmark their performance against nationwide standards or understand generalizability of existing research. Objective To address this gap in the literature by beginning to collect descriptive data on significant variables for youth care from a geographically and institutionally diverse group of on Child and Adolescent IPUs. Method A multi-institutional research team conducted a nationwide (US) survey of child and adolescent IPU clinicians using snowball sampling. Recruitment e-mails were sent to IPU groups in the American Psychological Association and the American Academy Child and Adolescent Psychiatry. Results The study yielded data from 12 institutions with a total of 20 IPUs, representing over 23,000 admissions in the years 2019 and 2020. The results of the survey show wide variability in institutional definitions of key variables (such as readmissions and safety events) as well as large ranges in length of stay, restraints, seclusions, and safety events. Conclusion This study reveals the importance of IPU clinical researchers taking steps to build a robust evidence base for IPU care, including developing consensus definitions of key variables and conceptualizing why high degrees of variability exist in important variables of IPU care. The survey results provide valuable insights for hospital systems, policymakers, and clinicians in the field of child and adolescent psychiatry.

Evaluation of a Dialectical Behavior Therapy Didactic for Medical Trainees in an Acute Adolescent Inpatient Psychiatric Unit.

Dialectical behavior therapy (DBT) is an evidence-based treatment for patients with suicidality and emotion dysregulation. There is increasing evidence of using DBT in psychiatric inpatient units for youth. On inpatient units, the majority of treatment is provided by psychiatry trainees, often with limited therapy experience. The study's objective was to assess the impact of a 1-h weekly DBT training for a range of medical trainees rotating through a child and adolescent acute inpatient unit. Participants were 55 medical students, psychiatry residents, and child and adolescent psychiatry fellows who rotated on an inpatient unit for youth and participated in a 1-h DBT didactic. There was one group who attended less than four sessions and the other attended 5 or more sessions. A pre- and post-method design was used to collect data on participants' confidence, competence, and knowledge of DBT and working with suicidal youth. Comparing pre- and post-data for all participants, the DBT training was found to lead to significant benefits for trainees' comfort with therapy, prioritizing therapy during inpatient care, knowledge of DBT, comfort with DBT, and confidence in treating children and adolescents with suicidality. There were no significant differences in the type of trainee or dose of training. This study supports the benefit of a brief DBT didactic to provide training to a wide range of trainees to improve therapeutic care in an inpatient psychiatric unit for youth.

Staff Perspectives: Why are adolescent inpatients secluded and what causes changes in rates of seclusion on a unit?

The use of seclusion in Adolescent Inpatient Psychiatric Units is being heavily scrutinised due to its forceful nature and potential to cause harm. This study aimed to understand staff perspectives on reasons for seclusion in an Adolescent Inpatient Psychiatric Unit. A mixed methods approach that included the Attitudes to Seclusion Survey followed by a semi-structured interview on the reasons for seclusion was used. We recruited 31 participants who worked on the unit of which 27 were involved in seclusion. The findings showed that the majority of staff view seclusion as undesirable and believe it should only be used out of necessity. However, there was disagreement among staff about the reasons why adolescents were secluded and whether those reasons were justified. Staff identified factors that contributed to increases in seclusion but also provided several ways in which seclusion could be reduced. These findings highlight a need for precision on what constitutes justifiable use of seclusion to reduce the potential for misuse. It also shows opportunities exist for further reduction in seclusion through teamwork and communication.

Psychoeducation group facilitation training for nurses: A quality improvement project.

According to the 2020-2021 National Survey of Children's Health, 23.3% of children and adolescents met criteria for one or more mental, emotional, developmental, or behavioral problems. However, the prevalence of depression, anxiety, and post traumatic stress disorder have risen dramatically since the COVID-19 pandemic, leading to an increase in suicidal ideations, completed suicides, and pediatric psychiatric hospitalizations. There is a critical need for high quality mental healthcare treatments, including psychoeducation. Inpatient psychiatric nurses are well positioned to lead psychoeducation groups, but few receive training. Nurses at a designated inpatient pediatric psychiatric unit expressed discomfort in facilitating psychoeducation groups. This is a one-group prepost and follow-up quality improvement study designed to improve the quality of psychoeducation group facilitation skills provided by nurses at a child and adolescent inpatient psychiatric unit. A convenience sample of nurses (N = 16) participated. Baseline (T1), post-test (T2), and follow-up (T3) data were collected regarding nurses' self-efficacy, evidence based-practice attitudes, and knowledge of psychoeducation group facilitation. Nurses received 45 min of psychoeducation group facilitation education and 15 min of skills simulation. The nurses' knowledge, self-efficacy, and attitudes toward evidence-based practice when facilitating psychoeducation groups increased significantly from the baseline to the post-test, which was sustained from the post-test to the follow-up period. Study findings indicate the importance of supporting nurses in their role of psychoeducation group facilitation through education and program structure. Further research is needed to assess longer term sustainability and efficacy in leading psychoeducation groups.

The Mental Health Toll of the COVID-19 Pandemic on Adolescents Receiving Inpatient Psychiatric Treatment.

Objective: During the COVID-19 pandemic, the prevalence of depression and anxiety among children and adolescents significantly increased, along with the number of visits to emergency departments due to suicidality and/or suicide attempts. Relatedly, health care workers experienced significant burnout and symptoms of anxiety, depression, and posttraumatic stress disorder during this time. However, the corresponding impact on psychiatric inpatient treatment has not yet been researched. We hypothesized that during the pandemic, adolescents hospitalized in an acute care psychiatric inpatient unit had increased incidents of suicide attempts and nonsuicidal self-injurious behaviors and of aggressive behaviors toward others, resulting in greater use of constant observation and restraints. Method: This study was a retrospective chart review based on electronic medical record data examining use of restraints and constant observation one year before the pandemic (March 2019 to February 2020) and 1 year following the onset of the pandemic (March 2020 to February 2021) in an acute-care adolescent (12 to 17 years old) psychiatric inpatient unit. Results: There were 571 admissions during the year before the pandemic and 500 admissions during the pandemic. The number of patients who were restrained (χ2 = 7.86, p = 0.005), number of patients who were placed on constant observation (χ2 = 13.41, p < 0.001), and number of constant observation orders per patient (χ2 = 91.90, p < 0.001) were all significantly greater during the pandemic. Conclusion: Psychiatrically hospitalized adolescents during the pandemic received more intensive interventions such as restraints and constant observation. Severe patient psychopathology and staff shortages, as well as limitations of and decreases to the dialectical behavior therapy program, may have been the contributing factor.

Characteristics of self-harm on an adolescent psychiatric inpatient unit based on neurodevelopmental diagnoses

IntroductionEngagement in self-harm is common among youth in psychiatric inpatient units, however the nature of self-harm may be different in psychiatric care due to the increased supervision and theoretically decreased access to typical means of self-harm. This study aims to describe daily reports of self-harm experienced during psychiatric inpatient stays among adolescents and compare these inpatient self-harm experiences based on neurodevelopmental diagnoses (NDDs, including autism) given that self-harm methods differ across NDD diagnostic groups outside of the inpatient unit. MethodsData were derived from a larger study of risk factors among a sample of 119 suicidal adolescent inpatients, recruited from a large, urban adolescent inpatient psychiatric unit. Participants answered a daily series of self-report questions, including items about self-harm engagement, frequency, and methods used since the last survey. ResultsThere was no difference in the number of participants who reported any engagement in self-harm based on diagnostic group (χ2 = 0.08, p = .96). There were also no differences in the frequency of self-harm across diagnostic groups (F = 2.40, p = .12). There were no differences in the use of any method across diagnostic groups (ps > 0.05). ConclusionsFindings revealed that in an inpatient unit where patients are presenting for self-harm risk, there are no significant differences in engagement, frequency, or methods used for self-harm based on autism and NDD status. These analyses provide valuable clinical information regarding a lack of differences in self-harm by these diagnostic subgroups. Future research should seek to further explore functional purposes of self-harm on inpatient unit and how this differs by diagnoses.

Space for youth mental health-coercive measure use before and after architectural innovation at a department of child and adolescent psychiatry.

Influence of architectural features in child and adolescent psychiatric wards on coercive measure use has not been investigated so far. We aimed to assess the effect of altering the physical environment of an adolescent psychiatric inpatient unit on the proportion and frequency of adolescents experiencing mechanical coercive measures. In a naturalistic observational design, coercive measures were compared before and after an architectural intervention facilitated by rebuilding a child and adolescent psychiatric department in October 2020. Age, gender, length of stay, main psychiatric diagnosis and indices of coercion in n = 782 admissions to inpatient child and adolescent psychiatry from April 2019 to April 2022 were extracted. Group comparisons were performed using chi-squared tests for categorical and Mann-Whitney U-tests for numerical variables. After structural modernization which included amplifying space and with the newly introduced availability of seclusion rooms, significantly fewer patients were affected by mechanical restraint (8.1% vs. 13.7%, p = .013). Rate of seclusion increased to 5.0% (vs. 0%, p < .001). Rate of seclusion and/or restraint decreased from 13.7% to 11.8% (p = .425). The median cumulative duration of all coercive measures per affected case decreased significantly (2.8 vs. 5.4 h, p = .005), as well as its proportion to length of stay (0.8% vs. 2.8%, p = .006). Modernisation and restructuring of buildings hosting psychiatric departments can contribute to a reduction of coercive measures in child and adolescent psychiatric units.

4.18 Changes in Hospitalization Demand Following the COVID-19 Pandemic in the Adolescent Psychiatric Inpatient Unit

4.18 Changes in Hospitalization Demand Following the COVID-19 Pandemic in the Adolescent Psychiatric Inpatient Unit

Year one review: Staff perception on the implementation of the chair restraint on an adolescent psychiatric inpatient unit.

The purpose of this project was to assess perceptions, thoughts, and feelings of psychiatric mental health nursing staff when utilizing the chair restraint on an adolescent unit. Furthermore, to explore decision making related to choosing the chair restraint verses choosing to use the six-point board as a safety management intervention. This was a phenomenological qualitative study, utilizing semistructured interviews to explore the experiences of nursing staff, consisting of behavioral health specialists, and direct-care staff nurses who work on an adolescent psychiatric unit utilizing both chair restraint and the six-point board. Ten nursing staff were interviewed. Using thematic analysis, staff perceptions, thoughts, and feelings when using mechanical restraints for safety management were explored. Demographics were collected however, there was no variability in the responses and saturation was reached. Five themes emerged from the interviews. The Five themes that emerged were: Restraint chair was less traumatic and preferred, feelings of defeat when de-escalation was not successful, pushing away emotions as protection, units were short staffed, and patient behaviors were seen as a potential barrier to eliminating the six-point board. The results of this study will be used to guide to further develop behavioral health education, orientation for new staff, and to understand ways to support staff through their experiences in managing a patient's unsafe behaviors.

The use of physical restraints and PRN medications in adolescent psychiatric inpatient units.

Although physical restraint practices and psychotropic/sedative pro re neta (PRN, as needed) medications have been commonly used for managing inpatient aggression, little is known about the characteristics of adolescents who receive them in psychiatric adolescent inpatient units. We aimed to determine the relationship between the use of physical restraints and psychotropic/sedative PRN medications, and to characterize individual attributes, substance use, clinical factors, and time of the first restraint episodes of the use of physical restraints and psychotropic/sedative PRN medications. A retrospective case-control study approach was used with the data from electronic health records at a pediatric psychiatric hospital in the United States. Descriptive statistics, χ2 , multivariate logistic regression, and Cox proportional hazard model were used. Participants of younger age and participants with a longer length of stay were significantly associated with the use of physical restraints and psychotropic/sedative PRN medications, although the substance-related risks were not significantly associated with the use of restraints. Physical restraints were more likely to have occurred soon after the admission and tapered off as the length of stay increased. This study provides important information in understanding the risk factors of the use of restraints and psychotropic/sedative PRN medications in psychiatric adolescent inpatient units.

Lived experiences of adolescents admitted for first-episode psychosis in South Africa.

First-episode psychosis is common in adolescents and can be distressful to the person experiencing it for the first time. However, there is limited research globally and specifically in Africa about the lived experiences of adolescents admitted into a psychiatric facility for first-episode psychosis. To understand the adolescents' experiences of psychosis and receiving treatment in a psychiatric facility. Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital, Cape Town, South Africa. This was a qualitative study that used purposive sampling to recruit 15 adolescents with first-episode psychosis and admitted to the Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital in Cape Town, South Africa. Individual interviews were audio recorded, transcribed and analysed using thematic analysis consisting of both inductive and deductive coding. The participants described negative experiences of their first episode psychosis, provided varying explanations for their first episode psychosis and had the insight that cannabis precipitated their episodes. They described both positive and negative interactions with both the other patients and staff. They did not wish to return to the hospital again following their discharge. Participants stated that they wanted to change their lives, return to school and try to prevent a second episode of psychosis. This study provides insights into the lived experiences of adolescents presenting with first-episode psychosis and calls for future research to delve deeper into factors that support or enable recovery among adolescents with psychosis. The findings of this study call for improving the quality of care in the management of first-episode psychosis in adolescents.

Prevalence and correlates of restrictive interventions in an Irish child and adolescent psychiatric unit: a 4-year retrospective study

BackgroundThere has been a global effort to reduce the use of restrictive interventions (RIs) in healthcare settings. In order to reduce unnecessary RIs, it is essential to understand their use in mental health settings. To date, there have been few studies examining the use of RIs in child and adolescent mental health settings, with no such studies in Ireland.AimsThe purpose of this study is to examine the prevalence and frequency of physical restraints and seclusion and to identify any associated demographic and clinical characteristics.MethodsThis is a 4-year retrospective study of the use of seclusion and physical restraint in an Irish child and adolescent psychiatric inpatient unit from 2018 to 2021. Computer-based data collection sheets and patient records were retrospectively reviewed. Eating disorder and non-eating disorder samples were analysed.ResultsOf 499 hospital admissions from 2018 to 2021, 6% (n = 29) had at least one episode of seclusion and 18% (n = 88) had at least one episode of physical restraint. Age, gender and ethnicity were not significantly associated with rates of RI. Unemployment, prior hospitalization, involuntary legal status and longer length of stay were significantly associated with higher rates of RIs in the non-eating disorder group. Involuntary legal status was associated with higher rates of physical restraint in the eating disorder group. Patients with a diagnosis of eating disorder and psychosis had the highest prevalence of physical restraints and seclusions respectively.ConclusionsIdentifying youth who are at greater risk of requiring RIs may allow early and targeted intervention and prevention.

1.66 Rates of Self-Reported Childhood Trauma in Youth Who Are Psychiatrically Hospitalized: Comparisons to a Population-Based Representative Community Sample

Youth who are psychiatrically admitted often underreport traumatic experiences during clinical interviews. To guide trauma-informed care (TIC) on a child and adolescent psychiatric inpatient unit, rates of self-reported trauma were compared to a community sample. We hypothesized that psychiatrically admitted youth will report higher rates of childhood emotional, physical, and sexual abuse than youth from a matched community sample, including those with clinically significant psychiatric symptoms.

Service Evaluation of COVID and Non-COVID Admission Trends to an East Midlands General Adolescent Psychiatric Inpatient Unit

AimsTo explore the differences in admissions between the first COVID-19 lockdown cohort and a pre-COVID-19 cohort.Methods23 young people who were admitted to an East Midlands General Adolescent Inpatient Unit during the first COVID-19 lockdown from March 2020 to September 2020 were compared with the 48 young people who were admitted in the same period in 2019. Demographic details, admission duration and reasons, mental health act (MHA) status, diagnoses, functional status, and incidents were obtained retrospectively from the trust's online records.ResultsThe unit received more female admissions prior to lockdown (60.4% Vs 47.8%). Approximately 30% of adolescents in the pre-COVID-19 group were not in education whereas those admitted during COVID-19 were all receiving education. More of the pre-COVID-19 group attended school than college and more of the COVID-19 group were employed, consistent with a lower mean age of admission in the former group. Most of the COVID-19 admissions were local and none were out of area. Young people were also more likely to be looked after by their parents during COVID-19 (82.6%) and none were taken care of by their relatives.Pre-COVID019 admissions were discharged sooner than their counterparts, which had 13% of admissions between 6–9 months. Both cohorts had mainly informal admissions due to risk to self. Most of the COVID-19 admissions were due to anxiety, followed by self-harm while the majority of pre-COVID-19 admissions were due to depression and PTSD. 43% of the COVID-19 admissions had at least one comorbid diagnosis, notably depression. More adolescents in the COVID-19 cohort were not started on any psychiatric medication during and after admission.The mean number of incidents were two times higher in the COVID-19 group; self-harm was the most common reason. There was more violence towards staff during lockdown. However, absconsion, possession of contraband items, and staff error were higher in the pre-COVID-19 group.ConclusionThe introduction of COVID-19 restrictions was associated with a change in both the frequency and nature of inpatient admissions to this ward. Less young people were admitted during COVID-19, more frequently with anxiety as the primary reason and stayed for longer. Although the pre-COVID-19 group received more psychiatric medication, it is unclear if this contributed to a better functional status overall. This service evaluation also demonstrated the impact of COVID-19 on young people's mental health and life circumstances. An exploration of these trends in other units across the country would increase the generalisability of results.

Increased severity of mental health symptoms among adolescent inpatients during COVID-19

ObjectivePrior research suggests that the COVID-19 pandemic has been detrimental to adolescent mental health. However, no research has examined whether the pandemic is associated with increased symptom severity among high-risk youth, such as those hospitalized for a psychiatric crisis. MethodOver a four-year period, upon admission to an adolescent psychiatric inpatient unit, youth completed measures of depression (Center for Epidemiologic Studies Depression Scale), feeling like a burden and lack of belongingness (Interpersonal Needs Questionnaire), trauma-related symptoms (Child Trauma Screen), suicidal thoughts and behaviors (Self-Injurious Thoughts and Behaviors Interview Self-Report Version). We compared the severity of these symptoms for patients admitted during the pandemic to the severity for patients admitted to the same unit in the three years before the pandemic. ResultsAcross most symptoms, youth hospitalized during the pandemic reported increased severity compared to those hospitalized before the pandemic. ConclusionsAdolescents requiring psychiatric hospitalization during the pandemic reported increased symptom severity compared to adolescents hospitalized on the same inpatient unit in the three years prior to the pandemic.

Reducing seclusion use in an Australian child and adolescent psychiatric inpatient unit

BackgroundIn inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions. MethodMulti-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions. ResultsThere was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July–September 2015, to 4.7 episodes in January–March 2016, reaching 0.0 episodes by April–June 2016. This reduction was maintained until April–June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant. LimitationsDue to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change. ConclusionsMultidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions.

Perspectives croisées des adolescents et des soignants sur les médiations thérapeutiques en psychiatrie : une étude qualitative

ObjectiveWe aimed to explore the adolescents’ and caregivers’ lived experiences during therapeutic mediation in an adolescent psychiatric inpatient unit. MethodsThis qualitative study, using semi-structured interviews and photo-elicitation, took place in the CHU of Rouen. Data were collected, until theoretical sufficiency was reached, through semi-structured interviews and a photo-elicitation tool. Inductive Process to analyze the Structure of Lived-Experience was used to process the data. ResultsEighteen participants were included, 10 caregivers and 8 teenagers. The crossed analyses of adolescents’ and caregivers’ interviews showed four lived experiences: to verbalize, to meet, to feel with the body and to grow up. The analysis concluded there was a divergence in the representation of the purpose of therapeutics mediations between adolescents and caregivers.Perspectives We suggest verbalization is not central. We propose to go through the body and to consider the reactivation of the separation individuation process.

21.6 The Effectiveness of Mindfulness Meditation and Nursing Education in Decreasing the Events of Insomnia, Emotional, and Behavioral Disturbances in an Adolescent Inpatient Psychiatric Unit

Mindfulness meditation practices have become increasingly popular in schools and medical settings. Meditation practices for insomnia is a safe, relatively inexpensive, low-risk, and easy-to-implement option for people who have difficulty accessing other types of therapy or medication. These interventions are relatively safer than pharmacological interventions and can have potential long-term benefits. This poster will analyze the reduction in the number of medications used to treat insomnia and affective disturbances in an inpatient adolescent psychiatric unit. Ten-minute mindfulness meditation groups were conducted on the unit as a part of a quality improvement project. This intervention was carried out 5 days a week for a total period of 3 months. Handouts were given to nursing staff on how to manage insomnia and agitation on the unit. Data were collected on the number of as-needed or emergent medications used to treat insomnia or agitation 3 months prior to the intervention and 3 months during the period of the study and then compared. A total of 51 adolescents admitted to the unit during the 3-month period of the study participated in the meditation groups. When compared to the baseline data of 42 adolescents in the 3 months prior to the initiation of the intervention, mean events of oral, as-needed, or emergent medications for agitation or insomnia decreased from 6.3 to 4.1 per adolescent (p > 0.05), and mean events of any medication, oral or intramuscular, prescribed for insomnia or agitation decreased from 6.8 to 4.6 per adolescent (p > 0.05). After comparing the 2 groups, there was a decrease in the number of episodes of agitation and insomnia on the unit; however, the difference did not reach statistical significance. Mindfulness meditation can be an effective strategy to reduce events of insomnia or agitation on the unit, and further studies may help in determining the effectiveness of this modality.

What Do We Do When Things Fall Apart? Rapid Creation of a Pilot Psychiatric Intensive Care Unit in Response to Increased Acuity on a Psychiatric Inpatient Unit for Children and Adolescents

ABSTRACT The past two decades have seen a sharp increase in suicide and psychiatric hospitalizations for children and adolescents. While many youth are served well in the inpatient psychiatry setting, a subset of this population does not stabilize during an average length of stay and with the typical therapeutic interventions provided by an inpatient unit. This study examines the creation of a psychiatric Intensive Care Unit (ICU) for patients who exhibited the most severe and acute mental illness, self-injury, and aggressive behaviors on a child and adolescent psychiatric inpatient unit. The ICU was created in response to increasing numbers of restraints, assaults, and patient and staff injuries in the months preceding creation of the program and potential contagion effect of safety issues amongst patients. Post-implementation, nominal reductions in safety metrics were found in both the ICU and general milieus for patient and staff injuries and assaults. Nominal decreases in restraints and self-injury were also found in the ICU. Significant decreases in property destruction were found in both milieus and restraints significantly decreased in the general milieu. In addition, patients who participated in the ICU milieu were less likely to be re-admitted to an inpatient psychiatric unit following hospitalization. Overall, the ICU was well-received by staff and patients’ caregivers.

COVID-19 Related Daily Stressors, Coping, and Suicidal Ideation in Psychiatrically Hospitalized Youth.

BackgroundGiven reports of the adverse effects of COVID-19 on adolescent mental health, it is critical to understand how it impacts psychiatrically hospitalized youth who may be particularly vulnerable to its effects.ObjectiveThis study aimed to advance our understanding of high-risk adolescents’ experiences of COVID-19, including COVID-19-related stress, changes in daily functioning, and coping as they relate to suicidal ideation (SI).MethodParticipants were 107 youth (ages 11–18; M = 15.06, SD = 1.79) admitted to an adolescent psychiatric inpatient unit during the time when the initial COVID-19 safety measures (i.e., school closure, stay-at-home- order) and reopening initiatives (Phase I, II, and III) were implemented in Rhode Island between March 13th and July 19th 2020. Adolescents completed measures of COVID-19-related stress, coping, functioning, and SI at the time of admission.ResultsNearly half of the sample (43%) reported a negative impact of COVID-19 on daily functioning. Youth who endorsed COVID-19-related decline in functioning evidenced higher levels of SI compared to youth with no change or improvement in functioning due to COVID-19. Overall levels of stress were not associated with SI. Greater coping repertoire, but not the use of specific coping strategies was associated with higher levels of SI.ConclusionsFindings demonstrate the importance of examining COVID-19-related changes in functioning and broadening repertoire of coping strategies among adolescents at high risk for SI.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10566-021-09641-1.