Adolescent Inpatient Treatment Research Articles

A hop, skip and a jump towards evaluating social interaction and learning through play at a child and adolescent inpatient treatment program.

The number of inpatient mental health facilities for children and adolescents in the United States is growing rapidly. While undergoing inpatient treatment, children and adolescents can benefit from innovative play opportunities designed to foster social interaction and learning. The Playful Learning Landscapes (PLL) initiative is a group of projects designed to transform everyday spaces into opportunities for playful learning. As a part of this initiative, two designs-Lifesize Ruler and Jumping Feet-were installed in an inpatient mental health facility for children and adolescents in the Mid-Atlantic region of the United States. Results of pre-installation and post-installation naturalistic observations suggested that social interactions, the use of STEM-related language and 21st century skills, including confidence, increased after interacting with the installations. While previous research on PLL projects has demonstrated the efficacy of transforming public spaces into places for playful learning, this research provides support that, even in private, targeted settings, using a trauma-informed approach, children and adolescents, can reap the benefits of playful learning.

Atypical anorexia nervosa: Rethinking the association between target weight and rehospitalization

ObjectiveBodyweight restoration is one of the most important targets in adolescent inpatient treatment of anorexia nervosa (AN). This study examined the association between achieving target weight and rehospitalization in two groups of adolescents with AN and atypical anorexia nervosa (AAN) admitted to a specialized inpatient unit. MethodIncluded were 202 adolescent patients hospitalized in a specialized eating disorder unit, 10–18 years old. One hundred fifty-four adolescents were diagnosed with AN, and 48 with AAN. We examined the patients' demographic and clinical characteristics, the achievement of treatment goals, and their rehospitalization history within a year of discharge from the unit. ResultsLog-linear regression indicated a significant association between achieving target weight during the inpatient program and rehospitalization at one-year follow-up in the AN group; this association was not significant in the AAN group. DiscussionThis study emphasizes the importance of differentiating patients with AAN from those with classical AN. Specifically, it raises questions about the predictive power of target weight at discharge in preventing relapse and its centrality in determining AAN patients' treatment plans.

Experience of adolescents in mental health inpatient units: A metasynthesis of qualitative evidence.

WHAT IS KNOWN ON THE SUBJECT?: Inpatient treatment is often necessary due to the vulnerability of adolescents' mental health, and hospitalization rates are increasing. There are both positive and negative experiences related to adolescent inpatient treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Inpatient ward environment and interactions with staff and peers are critical in adolescents' nursing care while undergoing inpatient treatment. Adolescents want their voice to be reflected in the treatment process, including within the discharge plan. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should establish a therapeutic milieu for adolescents to feel stable and safe so that inpatient treatment can become a positive experience. Mental health nurses should apply a person-centred approach to adolescents so that adolescents can participate in decision-making during the inpatient treatment process. ABSTRACT: Introduction Mental health inpatient treatment is necessary and increasing in adolescents due to their mental health vulnerability. Few studies have comprehensively reviewed adolescents' hospitalization experience. Aim To gain an in-depth understanding of the mental health inpatient experience from adolescents' perspectives. Method Six electronic databases, manual searches and citation searches were completed for studies published within the last 10years. Eight articles were included, and thematic analysis was used. The Critical Appraisal Skills Program (CASP) checklist was applied to assess data quality. Results Three main themes were identified: Experiences of hospitalization, perceived outcomes and preparing for discharge. These themes included both positive and negative experiences. Discussion The environment and interactions within the ward were critical to adolescents' nursing care. Positive relationship experiences were important for adolescents to adapt well and consequently achieve beneficial inpatient treatment results. Additionally, adolescents wanted to participate in the decision-making process related to their treatment during hospitalization. Implications for Practice Mental health nurses have a responsibility to be sensitive to adolescents' mental health status during hospitalization and to understand the significance of providers' support in leading them to recovery. Nurses need to establish a more stable ward environment and form positive relationships through respect for adolescents' intentions.

Using the Rorschach as a Group Intervention to Promote the Understanding of Adolescents by Staff Members in Inpatient Residential Programs

Abstract. Mental health professionals working in adolescent residential treatment facilities face various challenges in delivering effective treatment to their patients. Establishing therapeutic alliance is often regarded as particularly daunting. Adolescents’ acting-out behaviors, emotional dysregulation, and difficulty in trusting adults can trigger strong reactions in mental health professionals. These reactions may increase the risk that mental health professionals respond to adolescents’ behaviors in similarly unmodulated ways and become involved in a reciprocal pathological process. The Rorschach test can provide vivid imagery and response content that depicts the subjective dilemmas adolescents are struggling with during their recovery in the treatment center. In this paper we show how to use Rorschach imagery to allow the mental health professionals working in adolescent inpatient treatment centers to understand their patients and increase empathy in response to adolescents’ troubling behaviors. We illustrate this procedure through the case of an adolescent patient who engaged in severely disruptive acting-out behaviors with the treating staff. Even though the staff were considering terminating his treatment in the facility as the only viable option, they instead found new empathy and a way to work with him after discussion of his Rorschach led by the inpatient center psychologist.

Pediatric Nonsuicidal Self-Injury: A Call to Action for Inpatient Staff Training.

The rising prevalence of nonsuicidal self-injury (NSSI) in pediatric populations along with the recent inclusion of NSSI as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have increased the focus on the assessment and treatment of NSSI among youth. Despite the frequent occurrence of NSSI in inpatient psychiatric treatment settings, there are no empirically based assessment protocols to guide clinical staff. This article presents findings from a needs assessment conducted with staff at a state-run child and adolescent inpatient treatment facility. The purpose was to assess the need for formalized NSSI training among staff. A questionnaire was developed to evaluate whether staff had received formal training in NSSI assessment and treatment as well as typical practice responses to patients engaging in NSSI behaviors. The questionnaire also evaluated staff comfort and confidence in their knowledge and skills concerning the assessment and treatment of NSSI among children and adolescents. Respondents were 126 clinical staff, most of whom were nursing staff. Only a minority of staff reported having received formal NSSI training, and a third of respondents indicated that they do not typically assess for NSSI at all. Although a substantial percentage of clinical staff self-reported comfort and confidence with assessing and treating NSSI, fewer than 10% demonstrated accurate skill. Formal training in NSSI is associated with positive outcomes for both patients and staff in general healthcare settings. These findings suggest that similar training for staff on pediatric inpatient psychiatric units will likely foster comfort, confidence, and accuracy, thereby improving outcomes for children and adolescents engaging in NSSI behaviors.

Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011

Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children’s Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.

Attachment Based Short Intervention During Inpatient Treatment of Adolescents

Attachment Based Short Intervention During Inpatient Treatment of Adolescents In clinical attachment research the established and economic Adult Attachment Projective Picture System (AAP) has been increasingly used in the past few years to assess the attachment representations in adults and recent studies demonstrated sufficient validity for assessing attachment representations in adolescents. Apart from coding attachment classifications, the AAP provides useful and clinically valid information concerning attachment related defences, aspects of capacity to act and synchrony in relationships and emotion regulation strategies with respect to attachment related traumatic experiences. These valuable aspects with respect to individual resources led to the conceptualization to implement the AAP in the therapeutic setting as a feedback tool. In this pilot case we report on an adolescent patient in an inpatient setting. The therapist received an individualized feedback on the patients' AAP to focus on specific attachment related themes used as a short intervention respective an add-on treatment. This paper presents the first results of this new approach by demonstrating the potential therapeutic effects and process of therapy.

Naturalistic Outcome of Family-Based Inpatient Treatment for Adolescents with Anorexia Nervosa.

Outpatient family-based treatment (FBT) is the best-documented treatment for adolescent anorexia nervosa (AN), but research is scarce on FBT adapted to inpatient settings. The naturalistic outcome of inpatient FBT for adolescent AN was investigated. Thirty-seven (65%) of 57 patients who received inpatient FBT at a tertiary adolescent eating disorders (ED) unit participated in a follow-up interview (mean 4.5 ± 1.8, range 1-7years) that assessed ED symptoms and general psychological functioning. A majority (65%) had achieved a normal body weight (body mass index ≥18.5). Thirty-six per cent (n = 12) were classified as fully recovered, as defined by body mass index ≥18.5, ED Examination Questionnaire global ≤2.5, and no binge eating/purging over past 3months. Sixteen (43%) participants met criteria for one or more additional comorbid disorders. Inpatient family-based therapy for AN may be a promising therapeutic approach for adolescents that fail to respond to outpatient treatment and should be investigated further. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

An Adjunctive Multi-family Group Intervention with or without Patient Participation during an Inpatient Treatment for Adolescents with an Eating Disorder: A Pilot Study.

This study reports on a pilot study of a family group intervention with or without patient participation adjunctive to a specialized inpatient treatment for eating disorders (EDs). Participants were 112 female adolescent ED inpatients and one or both of their parents. The parents were invited to participate in an adjunctive multi-family group with patient (MFT) or in a similar multi-parent group without patient participation (MPT). Questionnaires assessing ED symptoms, family functioning and caregiving experiences were administered before and after intervention. Post-intervention results obtained from both patient and parent(s) indicated that improvement in ED symptoms and parental burden occurred after both types of interventions. Family functioning improved differently according to the informant: fathers reported an improvement of general family functioning, patients reported an improvement of problem solving and mothers reported a decrease in problem solving across both formats. This study emphasized the importance of including a multi-informant approach in family interventions. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Long-term outcomes after adolescent in-patient treatment due to alcohol intoxication: A control group study

BackgroundThe long-term psychosocial development of adolescents admitted to in-patient treatment with alcohol intoxication (AIA) is largely unknown. MethodsWe invited all 1603 AIAs and 641 age- and sex-matched controls, who had been hospitalized in one of five pediatric departments between 2000 and 2007, to participate in a telephone interview. 277 cases of AIA and 116 controls (mean age 24.2 years (SD 2.2); 46% female) could be studied 5–13 years (mean 8.3, SD 2.3) after the event. The control group consisted of subjects who were admitted due to conditions other than alcohol intoxication. Blood alcohol concentration on admission was systematically measured in the AIA but, owing to the retrospective study design, not in the control group. Subtle alcohol intoxication could therefore not be entirely ruled out in the control group. Long-term outcome measures included current DSM-5 alcohol use disorders (AUD), drinking patterns, illicit substance use, regular smoking, general life satisfaction, use of mental health treatment, and delinquency. ResultsAIA had a significantly elevated risk to engage in problematic habitual alcohol use, to exhibit delinquent behaviors, and to use illicit substances in young adulthood compared to the control group. Severe AUD also occurred considerably more often in the AIA than the control group. ConclusionsIn the majority of AIAs, further development until their mid-twenties appears to be unremarkable. However, their risk to develop severe AUD and other problematic outcomes is significantly increased. This finding calls for a diagnostic instrument distinguishing between high- and low-risk AIAs already in the emergency room.

Ethical Issues Surrounding In-Patient Treatment for Adolescents with Substance Use Disorders

C l i n M e d International Library Citation: Roemer A (2015) Ethical Issues Surrounding In-Patient Treatment for Adolescents with Substance Use Disorders. Int Arch Addict Res Med 1:007 Received: June 17, 2015: Accepted: August 09, 2015: Published: August 12, 2015 Copyright: © 2015 Roemer A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Roemer. Int Arch Addict Res Med 2015, 1:2

Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome.

This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders.

Implementing music therapy on an adolescent inpatient unit: a mixed-methods evaluation of acceptability, experience of participation and perceived impact.

We aimed to assess the feasibility of delivering a music therapy program on adolescent psychiatric wards. We undertook a mixed-methods evaluation of a pilot program. Various active and receptive techniques were employed in group music therapy sessions delivered as part of a structured clinical program. Data collected in interviews with participants and staff and feedback questionnaires were thematically and descriptively analysed and triangulated. Data from 62 questionnaires returned by 43 patients who took part in 16 music therapy sessions, and seven staff, evidenced strong support for music therapy. Patients typically reported experiencing sessions as relaxing, comforting, uplifting, and empowering; >90% would participate by choice and use music therapeutically in the future. Staff endorsed music therapy as valuable therapeutically, reporting that patients engaged enthusiastically and identified sessions as improving their own moods and ward milieu. Integration of music therapy in inpatient treatment of adolescents is feasible and acceptable, and is valued by staff and patients as a complement to 'talking therapies'. Participation is enjoyed and associated with outcomes including improvement in mood, expression of feelings and social engagement consistent with recovery.

Etiology and Management of Abnormal Uterine Bleeding in Adolescents Admitted to a Children’s Hospital Over a Nine -Year Period, 2005-2013

Abnormal Uterine Bleeding (AUB) resulting in anemia is a common gynecologic reason for hospitalization of adolescent girls. Frequently reported etiologies include anovulation due to immaturity of the hypothalamic-pituitary-ovarian (HPO) axis and bleeding diatheses. There is a lack of consensus on the optimal inpatient treatment for adolescents with AUB. The objective of this study is to describe the etiology and management of AUB in urban, predominantly minority adolescents admitted to a children’s hospital with a protocol for assessing and managing girls with AUB.

Reducing seclusion and restraint during child and adolescent inpatient treatment: still an underdeveloped area of research.

Half of all youth hospitalized in inpatient psychiatric facilities manifest aggressive behavior. When aggression escalates to the point of danger, measures must be employed to guarantee safety of both patients and staff. In this paper, the current empirical evidence for intervention models to reduce restriction and restraint utilization in children and adolescents is reviewed. PubMed and PsycINFO were searched for English-language articles published between 2006 and 2013. Included were empirical studies of child or adolescent inpatient populations using a pretest and posttest design. Included in this review are three empirical papers describing two different intervention models that met the inclusion criteria. The review indicates there are two empirical supported intervention models that are helpful in reducing seclusion and restraint utilization in children and adolescents. The promising empirical findings support evidence and application to the child/adolescent population for at least three of the six National Association of State Mental Health Program Directors core strategies for restraint reduction. The modest number of empirical papers reflects that reducing restrictive measures in child/adolescent inpatient treatment remains an underdeveloped area of research.

19: Cost Analysis of Inpatient Treatment of Adolescents with Anorexia Nervosa: Hospital and Societal Perspectives

19: Cost Analysis of Inpatient Treatment of Adolescents with Anorexia Nervosa: Hospital and Societal Perspectives

Non-suicidal self-injury (Nssi) in adolescent inpatients: assessing personality features and attitude toward death

BackgroundNon-suicidal self-injury (NSSI) is a common concern among hospitalized adolescents, and can have significant implications for short and long-term prognosis. Little research has been devoted on how personality features in severely ill adolescents interact with NSSI and "attitude toward life and death" as a dimension of suicidality. Developing more specific assessment methodologies for adolescents who engage in self-harm without suicidal intent is relevant given the recent proposal of a non-suicidal self-injury (NSSI) disorder and may be useful in predicting risk in psychiatrically impaired subjects.MethodsConsecutively hospitalized adolescents in a psychiatric unit (N = 52; 71% females; age 12-19 years), reporting at least one recent episode of self-harm according to the Deliberate Self-harm Inventory, were administered the Structured Clinical Interview for DSM Mental Disorders and Personality Disorders (SCID I and II), the Children's Depression Inventory and the Multi-Attitude Suicide Tendency Scale (MAST).ResultsMean age onset of NSSI in the sample was 12.3 years. All patients showed "repetitive" NSSI (high frequency of self-harm), covering different modalities. Results revealed that 63.5% of adolescents met criteria for Borderline Personality Disorder (BPD) and that the rest of the sample also met criteria for personality disorders with dysregulated traits. History of suicide attempts was present in 46.1% of cases. Elevated depressive traits were found in 53.8%. Results show a statistically significant negative correlation between the score on the "Attraction to Life" subscale of the MAST and the frequency and diversification of self-harming behaviors.ConclusionsMost adolescent inpatients with NSSI met criteria for emotionally dysregulated personality disorders, and showed a reduced "attraction to life" disposition and significant depressive symptoms. This peculiar psychopathological configuration must be addressed in the treatment of adolescent inpatients engaging in NSSI and taken into account for the prevention of suicidal behavior in self-injuring adolescents who do not exhibit an explicit intent to die.

Changes in Patient Measures as Predictors of Therapists’ Ratings of Treatment Collaboration and Change in Eating Disorder Subgroups

This study examined how implicit and explicit changes following integrative inpatient treatment of adolescents with eating disorder (ED) may predict the posttreatment ratings of psychodynamic therapists of their patients' openness to therapeutic processes and their change (Therapist Evaluation Inventory). The relative contribution of inpatients' ego functions was compared with that of their mental distress and ED symptoms in two subgroups: restricting type anorexia (AN-R) and binging/purging type EDs (B/P). Data indicated that the implicit personality variable of elevated ability to modulate affects was the best predictor of therapist-rated global outcome among patients with B/P symptoms, whereas in patients with AN-R, evolving openness to implicit negative affects and a reduction in reported distress were best predictors. In patients with AN-R, attenuated affect control was also significantly correlated with therapist posttreatment ratings. These data point that in addition to addressing behavioral/symptomatic aspects, personality variables should be addressed in the psychological treatment of EDs.

Adolescent inpatient treatment for anorexia nervosa: a qualitative study exploring young adults' retrospective views of treatment and discharge

AbstractObjectiveTo explore young adults' views regarding: the inpatient treatment they received for anorexia nervosa during their adolescences; their experiences of discharge; and the impact their admission had on issues of control and low self‐esteem.MethodSemi‐structured interviews were conducted with seven young adults treated in general adolescent psychiatric units. Data were analysed using Interpretative Phenomenological Analysis.ResultsFour super‐ordinate themes emerged from participants' accounts: (1) Removal from normality versus connecting with the outside world; (2) Treated as another anorexic versus a unique individual in distress; (3) Control and collaboration; (4) The importance of peer relationships.DiscussionFindings unique to this study concerned a sense of feeling removed and disconnected from ‘normality’; a feeling that one's developmental needs were not always addressed; and the importance placed on supportive relationships with fellow patients. It was also found that authoritarian approaches may compound patients' feelings of ineffectiveness, worthlessness and isolation. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.

Patterns of weekly weight gain during inpatient treatment for adolescents with anorexia nervosa

Background There is variation in the literature concerning optimum weekly weight gain for inpatient treatment of anorexia nervosa. The recently published UK National Institute for Clinical Excellence guidelines recommend 0.5–1.0 kg. Methods Weight gain was retrospectively compared for 53 inpatients admitted consecutively to an NHS adolescent anorexia nervosa unit. Results Mean weekly weight gain achieved was 0.82 kg, with no significant differences between patients who did or did not reach a target weight range, nor those who had or had not had previous inpatient treatment. Variation in mean weekly weight gain between patients approximated to a normal distribution. Patients admitted with a lower per cent expected BMI gained weight significantly faster. Weight gain was initially low, corresponding to low caloric intake, then faster, but tailed off as patients approached target weight range. Discussion Rate of weight gain was within NICE guideline recommendations. This still leaves questions as to optimum rate of weight gain. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.