Psychiatric Treatment Settings Research Articles

Patient Satisfaction with Psychological Treatment on a Voluntary Inpatient Psychiatric Unit.

Despite the empirical literature suggesting the benefits of providing patient support and psychotherapy, research examining patient satisfaction with psychological services integrated within inpatient psychiatric treatment settings remains scarce. A sample of 122 adults within a voluntary inpatient psychiatric unit, who were receiving psychological services completed a satisfaction questionnaire. Overall, participants reported high levels of satisfaction with psychological services and perceived them as helpful to their overall care. These results remained consistent when exploratorily examining satisfaction and helpfulness prior to and during the COVID-19 pandemic. These findings suggest the importance of integrating psychologists within inpatient psychiatric treatment settings. Future research may investigate the influence of psychological services on patient outcomes and how psychologists are perceived by other treatment team members.

5.51 Sexual Abuse Prevalence Is Higher in LGBTQ+ Adolescents in a Residential Psychiatric Treatment Setting

5.51 Sexual Abuse Prevalence Is Higher in LGBTQ+ Adolescents in a Residential Psychiatric Treatment Setting

Technology Implementation for Mental Health End Users: A Model to Guide Digital Transformation for Inpatient Mental Health Professionals.

Digital transformation is the adoption of digital technologies by an entity in an effort to increase operational efficiency. In mental health care, digital transformation entails technology implementation to improve the quality of care and mental health outcomes. Most psychiatric hospitals rely heavily on "high-touch" interventions or those that require in-person, face-to-face interaction with the patient. Those that are exploring digital mental health care interventions, particularly for outpatient care, often copiously commit to the "high-tech" model, losing the crucial human element. The process of digital transformation, especially within acute psychiatric treatment settings, is in its infancy. Existing implementation models outline the development of patient-facing treatment interventions within the primary care system; however, to our knowledge, there is no proposed or established model for implementing a new provider-facing ministration tool within an acute inpatient psychiatric setting. Solving the complex challenges within mental health care demands that new mental health technology is developed in concert with a use protocol by and for the inpatient mental health professional (IMHP; the end user), allowing the "high-touch" to inform the "high-tech" and vice versa. Therefore, in this viewpoint article, we propose the Technology Implementation for Mental-Health End-Users framework, which outlines the process for developing a prototype of an IMHP-facing digital intervention tool in parallel with a protocol for the IMHP end user to deliver the intervention. By balancing the design of the digital mental health care intervention tool with IMHP end user resource development, we can significantly improve mental health outcomes and pioneer digital transformation nationwide.

Adverse incidents and therapy options for opioid use disorders in forensic psychiatry

IntroductionPatients admitted into Forensic Clinics for Dependency Diseases (FCDD) in Germany are diagnosed with at least one substance use disorder. Opioid use disorders is common in this clinical population. Surprisingly, data on the availability and practice of opioid substitution treatment (OST) options in German FCDD according to Sect. 64 of the German Criminal Code (StGB) is scarce. Additionally, important data on the prevalence of adverse incidents such as violent behavior, relapse or escape from the clinic are missing for this highly specific treatment setting.ObjectivesOur aim ewas to describe the clinical practice regarding opioid substitution therapy in forensic psychiatry in Germany and to identify the prevalence of relevant adverse incidents during the therapy process.MethodsWe conducted a observational study including all FCDD units in Germany via a questionnaire. We assessed the clinical practice and total number of patients that received an OST, clinical reasons for beginning and ending the OST, number of treatments terminated without success, number of successful treatments and relevant adverse incidents such as violent behavior, relapse, escape and reoffending. The data was analyzed descriptively.Results15 of the existing 46 FCDD participated in our study (33%). In total, 2483 patients were treated in the participating FCDD, 18% of the patients were relocated into prison due to treatment termination and 15% were discharged successfully. 275 adverse incidents were reported: violence against a patient (4%), violence against staff (1,6%), escape (4,7%) and reoffending (0,5%). Merely in seven FCDD treating 1153 patients, an OST was availabe. Available options included buprenorphine/naloxone, buprenorphine, methadone and levomethadone. Regarding adverse incidents and successful discharge, no differences were detected in the clinics with or without an OST. In the clinics that offered an OST, we found a significantly higher rate for treatment termination without success (p<0.007) in comparison to clinics without this program. 99 patients received an OAT and this treatment was ended due to illegal drug abuse (57%), refusal to give an urine drug sample (71%) and in cases were the OAT was given away to other patients (85%).ConclusionsSurprisingly, opioid substitution therapy is only accessible in a part of the FCDD in Germany. Reasons for this are unclear. Critical incidents such as violent behavior against staff/patients and escape are not uncommon in this forensic psychiatric treatment setting. Further studies are needed to enhance the understanding of the limited OST practice and the risks for patients and staff in this specific forensic treatment setting.Disclosure of InterestNone Declared

Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study.

There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population. Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors. The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501). Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.

A review and comparative analysis of the risk-needs-responsivity, good lives, and recovery models in forensic psychiatric treatment.

Forensic mental health care primarily focuses on aspects of safety. Treatment is involuntary, and personal rights are highly restricted. Both direct and indirect coercion and significant power imbalances can impede not only the psychological state of inpatients but also their treatment motivation and the therapeutic process in general. However, successful treatment is essential to enable patients to regain their freedom. Therefore, the question arises whether and how health professionals, without disregarding the potential risks, can enable forensic psychiatric patients to experience meaningfulness and self-efficacy in their lives. In offender rehabilitation, the Risk-Need-Responsivity (RNR) model and Good Lives Model (GLM) are widely established theories. The RNR model focuses not only on the risk of recidivism but also on those needs of a person that provoke or prevent criminal behavior and the individual's ability to respond to various kinds of interventions. In contrast, the GLM aims to reduce the risk of re-offending by enabling an individual to live a "good life," i.e., a meaningful and fulfilling life. Originally developed in correctional services, i.e., for offenders without severe mental disorders, both the RNR model and the GLM have also been tested in forensic psychiatric treatment contexts. The Recovery Model is based on the concept of personal recovery in mental health care and is understood as the development of a sense of purpose and mastery in one's own life during the process of coping with the sequelae of a mental disorder. It is a central element of rehabilitation in general, but is also being increasingly applied in forensic psychiatric treatment settings. This review aims to compare the central concepts of the three models, in particular regarding personal development, and the current evidence for their efficacy in mentally disordered offenders.

WALKING THE WALK: PRACTICAL TIPS TO MAKE EXERCISE PART OF YOUR TREATMENT

There is growing evidence that physical activity is an effective and tolerable treatment for a variety of mental health disorders in childhood and adolescence. And yet, exercise remains an underutilized intervention for the treatment of mental health disorders in youth. This Workshop will provide participants with practical skills to successfully incorporate exercise into a variety psychiatric treatment settings and consolidate this knowledge through movement exercises taught in real time.

Effectiveness of Artificial Intelligence Methods in Personalized Aggression Risk Prediction within Inpatient Psychiatric Treatment Settings-A Systematic Review.

Aggression risk assessments are vital to prevent injuries and morbidities amongst patients and staff in psychiatric settings. More recent studies have harnessed artificial intelligence (AI) methods such as machine learning algorithms to determine factors associated with aggression in psychiatric treatment settings. In this review, using Cooper’s five-stage review framework, we aimed to evaluate the: (1) predictive accuracy, and (2) clinical variables associated with AI-based aggression risk prediction amongst psychiatric inpatients. Databases including PubMed, Cochrane, Scopus, PsycINFO, CINAHL were searched for relevant articles until April 2022. The eight included studies were independently evaluated using critical appraisal tools for systematic review developed by Joanna Briggs Institute. Most of the studies (87.5%) examined health records in predicting aggression and reported acceptable to excellent accuracy with specific machine learning algorithms employed (area under curve range 0.75–0.87). No particular machine learning algorithm outperformed the others consistently across studies (area under curve range 0.61–0.87). Relevant factors identified with aggression related to demographic and social profile, past aggression, forensic history, other psychiatric history, psychopathology, challenging behaviors and management domains. The limited extant studies have highlighted a potential role for the use of AI methods to clarify factors associated with aggression in psychiatric inpatient treatment settings.

Executive Dysfunction, Psychiatric Symptoms, and Behavioral Dysregulation in Preschoolers: Preliminary Findings in a Clinical Sample

ABSTRACT Children with deficits in executive function are at risk for poor outcomes in academic, social-emotional, and behavioral domains. These deficits have been particularly well documented in school-aged children with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders. However, there have been fewer studies exploring the links between executive function and psychopathology in preschool-aged children, particularly among young children with diagnosed psychiatric disorders and significant clinical impairment. This study examined associations between executive dysfunction, psychiatric symptoms, and behavioral dysregulation in a sample of 44 preschoolers participating in an intensive psychiatric day treatment program. The NIH Toolbox Early Childhood Cognition Battery was used to assess EF, including inhibitory control and cognitive flexibility, and parent-reported assessments were used to examine child psychiatric symptoms and behavioral dysregulation. Analyses using linear and logistic regression equation modeling suggest that executive dysfunction – particularly cognitive inflexibility – is a significant predictor of ADHD symptoms and behavioral dysregulation in clinically-referred preschoolers. Findings are discussed with respect to the role of executive dysfunction in early childhood psychopathology, with implications for treatment. Findings also suggest the NIH Toolbox is feasible for use in an early childhood psychiatric treatment setting and provides valid neurocognitive results to inform treatment planning and clinical care.

Direct costs of hospital care of self-harm: A national register-based cohort study.

To estimate national direct hospital costs associated with treatment of self-harm and to analyse whether costs differ with respect to demographic and clinical characteristics. A cohort design was applied to register data on all people living in Denmark (5.8million inhabitants) from Jan 1, 2012 to Dec 31, 2016. Self-harm presentations at all hospitals by persons aged 10years and older were included. Total costs and costs related to somatic and psychiatric care and treatment setting (inpatient, emergency department and outpatient) were calculated (in US dollars). The association between specific characteristics and somatic inpatient costs was analysed adjusted using generalized linear models and expressed as Odds Ratios (OR). In all, 42,634 (97.3%) self-harm presentations by 30,366 persons were included. Annual somatic and psychiatric costs amounted to $25,241,518 and $34,696,388, respectively, and the median cost per episode was $2248 (IQR: $1553-$4138). Predictors of high somatic inpatient costs were: admission to intensive care (OR = 15.6; 95% CI, 13.7-17.9), particularly dangerous methods of self-harm, such as being hit by moving objects (OR = 6.5; 95% CI, 2.7-15.7) and shooting (OR = 6.0; 95% CI, 3.4-10.7), and age ≥75years (OR = 1.8; 95% CI, 1.5-2.2). A small group of persons (0.7%) with ≥10 presentations accounted for 8.2% of somatic and 15.3% of total hospital costs. Substantial hospital costs were noted for inpatient treatment. Although one-time presenters accounted for the major share of costs, smaller patient groups accounted for considerable shares. Hospital costs of self-harm should be included in evaluation of initiatives for prevention and treatment.

Written exposure therapy for posttraumatic stress symptoms and suicide risk: Design and methodology of a randomized controlled trial with patients on a military psychiatric inpatient unit

Studies of active duty service members have shown that military personnel who screen positive for posttraumatic stress disorder (PTSD) are more than twice as likely to make a suicide attempt. Evidence-based PTSD treatments can reduce suicidal ideation; however, it can be challenging to provide evidence-based, trauma-focused, PTSD treatment to high-risk patients on an acute psychiatric inpatient unit because the priority of care is stabilization. Treatment for PTSD requires more time and resources than are typically afforded during inpatient hospitalizations. Written Exposure Therapy is an evidence-based, five-session, trauma-focused treatment for PTSD that may overcome the implementation challenges of providing PTSD treatment in an acute inpatient psychiatric treatment setting. This paper describes the design, methodology, and protocol of a randomized clinical trial. The goal of the study is to determine if five 60-min sessions of Written Exposure Therapy enhanced with Crisis Response Planning for suicide risk reduces the presence, frequency, and severity of suicidal ideation, suicidal behavior, rehospitalization, and non-suicidal, self-injurious behaviors. The study also will determine if Written Exposure Therapy for Suicide reduces posttraumatic stress symptom severity among military service members, veterans, and other adult military beneficiaries admitted to an acute psychiatric inpatient unit for comorbid suicide ideation or attempt and PTSD symptoms compared with Treatment as Usual. The study is designed to enhance the delivery of care for those in acute suicidal crisis with comorbid PTSD symptoms.

Exploring Technology-Based Enhancements to Inpatient and Residential Treatment for Young Adult Women with Co-Occurring Substance Use

Objectives Young adults have the highest rates of substance use of any age group. Although men historically have higher rates of substance use disorders (SUDs) than women, research shows this gender gap is narrowing. Young adults with comorbid psychiatric disorders are at increased risk for developing a SUD. Co-occurring psychiatric disorders such as depression, anxiety, eating and post-traumatic stress disorders are more prevalent in women than men with SUDs, yet mental health treatment often does not adequately address substance use in patients receiving care for a comorbid psychiatric disorder. Tailored gender-responsive interventions for women with psychiatric disorders and co-occurring SUD have gained empirical support. Digital interventions tailored to young adult women with co-occurring disorders have the potential to overcome barriers to addressing substance use for young adult women in a psychiatric treatment setting. This study utilized a user-centered design process to better understand how technology could be used to address substance use in young adult women receiving inpatient and residential psychiatric care. Methods: Women (N = 15; age 18–25 years), recruited from five psychiatric treatment programs, engaged in a qualitative interview and completed self-report surveys on technology use and acceptability. Qualitative interviews were coded for salient themes. Results: Results showed that few participants were currently using mental health web-based applications (i.e., “apps”), but most participants expressed an interest in using apps as part of their mental health treatment. Participants identified several important topics salient to women their age including substance use and sexual assault, stigma and shame, difficulties abstaining from substance use while maintaining social relationships with peers, and negative emotions as a trigger for use. Conclusions: These data provide preliminary evidence that a digital intervention may be a feasible way to address co-occurring substance use problems in young adult women receiving care in a psychiatric setting.

Management of Geriatric Bipolar Disorder: A Case Series and Review of Current Evidence-Based Treatment Guidelines

Bipolar disorder is a severe, relapsing mental illness, with recurrent episodes of altered mood that interfere with cognition and functioning. Although prevalence of bipolar disorder decreases with age, the absolute number of older adults with bipolar disorder is expected to increase with the aging population. Bipolar disorder is a frequent reason for psychiatric hospitalization in later-life, with prevalence rates in psychiatric inpatient treatment settings ranging from 4.7%–18.5%. There are several challenges in the management of geriatric bipolar disorder. Due to physiologic changes, comorbid medical conditions, and often polypharmacy, older adults are at higher risk for adverse effects of medications used to treat bipolar disorder. The disorder itself often impairs insight and treatment adherence. Additionally, response to medication is often incomplete, and later-life bipolar disorder is associated with persisting disability, cognitive impairment, increased mortality, and increased risk of suicide. Finally, limited data are available on use of medications and psychotherapies for older patients with bipolar disorder. Many of the current treatment approaches to bipolar disorder in later life are based on results from clinical trials in younger populations, extrapolated to the geriatric population. During this session, presenters will: 1) Describe current pharmacologic practice patterns and real-world challenges in clinical practice for older adults with bipolar disorder, through summary of a clinical case series of 50 older veterans diagnosed with bipolar disorder and engaged in longitudinal outpatient mental health care at the Minneapolis Veterans affairs medical center; 2) Review the most current literature on evidence-based treatment guidelines for geriatric bipolar disorder; 3) Identify limitations in existing guidelines, through comparison of real-world practice with current research evidence; 4) Propose future steps in geriatric bipolar disorder research that will help fill the existing gaps between the current evidence and clinical practice.

An Embodied Artistic Inquiry into Attachment-Oriented Therapeutic Relationships

In this study, I utilized an embodied artistic inquiry self-study to explore my experience of attachment in the therapeutic movement relationships (TMR) created as a dance/movement therapy intern at a psychiatric residential treatment center for children. The research was guided by three questions: How do I experience the TMR with children in a psychiatric residential treatment setting using attachment theory? How is my personal attachment style influencing and guiding the therapeutic relationship? How does my identification of salient moments relate to my own attachment style and aesthetic preference? Data were collected using journal entries that reflected on the researcher’s experience of attachment, saliency, and Tortora’s D.A.N.C.E. qualities of attachment (Clin Soc Work J 38(1):37–50, https://doi.org/10.1007/s10615-009-0254-9, 2010). I analyzed the data using discussion and Authentic Movement with a research consultant in order to synthesize and describe the experience of each salient moment. Repeated movements included grounded and unstable walking, changing of levels, core-distal movements, circling and carving arms, and recuperation. The themes that resulted from repeated movements and discussion with the research consultant include foundational movements, holding discomfort, connection to a specific client, and playfulness. These results reinforced the importance of stability and self-awareness for a therapist especially in relationship to how their movement and nonverbal preferences may have been learned from attachment relationships. Furthermore, results show the impact of saliency and the clinician’s aesthetic preference. In addition, the results reflected the strong relationship among nonverbal qualities of attachment and the TMR. These results suggested that qualities of attachment underlie the effectiveness of the TMR. Although limitations of the study prevented me from drawing correlative conclusions, the therapist may be able to strengthen the therapeutic relationship by targeting primary attachment models, and suggestions for further research are included.

Tobacco Use Predicts Treatment Dropout and Outcome in an Acute, Transdiagnostic Psychiatric Treatment Setting

Tobacco use is consistently associated with greater levels of depression and anxiety, broadly, and preliminary evidence suggests that current tobacco use is a significant predictor of dropout from psychiatric treatment. The current study extends past work to examine the impact of tobacco use on treatment dropout and outcomes in an acute psychiatric treatment setting. Upon intake to a partial hospitalization program (PHP), patients completed a battery of measures assessing sociodemographic characteristics, current tobacco use, depression and generalized anxiety, and substance use. Patients at the PHP also completed measures assessing levels of depression and generalized anxiety again upon discharge from the program. In line with hypotheses, current tobacco use was a significant predictor of dropout from treatment at the PHP. Importantly, this relationship remained significant when statistically controlling for demographic variables and psychiatric and substance use severity (such as number of previous inpatient psychiatric hospitalizations and degree of alcohol or drug problems). Results from the current study indicate that tobacco use is a significant risk factor for treatment dropout. Further research is needed to replicate these findings and to determine the mechanism underlying this link between tobacco use and treatment dropout for people receiving intensive psychiatric care.

Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample

BackgroundPublic perceptions of mental illness are increasingly construed in neurobiological and genetic terms. Accumulating evidence suggests there are some unintended consequences of these explanations, including reduced optimism for recovery among individuals with depression. However, little is known about how these beliefs relate to treatment process and outcomes in a psychiatric treatment setting, a gap this study aimed to fill. MethodsWe examined etiological beliefs about depression in a sample of patients (N = 279) seeking acute treatment in a behaviorally-based therapy program at a psychiatric hospital and examined relations with treatment expectations and outcomes. ResultsWe found that although psychosocial explanations of depression were most popular, biogenetic beliefs, particularly the belief that depression is caused by a chemical imbalance, were prevalent in this sample. Further, the chemical imbalance belief related to poorer treatment expectations. This relationship was moderated by symptoms of depression, with more depressed individuals showing a stronger relationship between chemical imbalance beliefs and lower treatment expectations. Finally, the chemical imbalance belief predicted more depressive symptoms after the treatment program ended for a 2-week measure of depression (but not for a 24-hour measure of depression), controlling for psychiatric symptoms at admission, inpatient hospitalizations, and treatment expectations. LimitationsThe sample was homogenous in terms of race and ethnicity and we did not assess how patients came to their beliefs. ConclusionsTogether, the results illustrate the correlates and possible impacts of etiological beliefs in a real-world clinical setting and invite a critical discussion about predominant messages about the etiology of depression.

MANAGEMENT OF GERIATRIC BIPOLAR DISORDER: A CASE SERIES AND REVIEW OF CURRENT EVIDENCE-BASED TREATMENT GUIDELINES

Bipolar disorder is a severe, relapsing mental illness, with recurrent episodes of altered mood that interfere with cognition and functioning. Although prevalence of bipolar disorder decreases with age, the absolute number of older adults with bipolar disorder is expected to increase with the aging population. Bipolar disorder is a frequent reason for psychiatric hospitalization in later-life, with prevalence rates in psychiatric inpatient treatment settings ranging from 4.7%–18.5%. There are several challenges in the management of geriatric bipolar disorder. Due to physiologic changes, comorbid medical conditions, and often polypharmacy, older adults are at higher risk for adverse effects of medications used to treat bipolar disorder. The disorder itself often impairs insight and treatment adherence. Additionally, response to medication is often incomplete, and later-life bipolar disorder is associated with persisting disability, cognitive impairment, increased mortality, and increased risk of suicide. Finally, limited data are available on use of medications and psychotherapies for older patients with bipolar disorder. Many of the current treatment approaches to bipolar disorder in later life are based on results from clinical trials in younger populations, extrapolated to the geriatric population. During this session, presenters will: 1) Describe current pharmacologic practice patterns and real-world challenges in clinical practice for older adults with bipolar disorder, through summary of a clinical case series of 50 older veterans diagnosed with bipolar disorder and engaged in longitudinal outpatient mental health care at the Minneapolis Veterans affairs medical center; 2) Review the most current literature on evidence-based treatment guidelines for geriatric bipolar disorder; 3) Identify limitations in existing guidelines, through comparison of real-world practice with current research evidence; 4) Propose future steps in geriatric bipolar disorder research that will help fill the existing gaps between the current evidence and clinical practice.

CHALLENGES IN EATING DISORDER TREATMENT: INPATIENT, OUTPATIENT, COMORBID, AND BEYOND

Eating disorders are potentially fatal and highly impairing disorders that can present with medical and psychiatric acuity and complexity. Additionally, comorbidity is common. This Clinical Perspectives will explore specific challenges in treating eating disorders, including discussions from both medical and psychiatric inpatient and outpatient treatment settings, and the impact of comorbid substance abuse.

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.

Illness perceptions of youths with functional disorders and their parents: An interpretative phenomenological analysis study.

Functional disorders, defined as disorders with no clear medical explanation, are common and impose a significant burden on youths, their families, healthcare services and society as a whole. Currently, the literature describes resistance among patients and their families towards psychological symptom explanations and treatments. More knowledge about the thoughts and understandings of youths with functional disorders and their parents is needed. The aim of this study was to explore the illness perceptions of youths with severe functional disorders and their parents. A qualitative interview study using interpretative phenomenological analyses. The study included 11 youths aged 11-15 years with functional disorders and their parents, where interviews were performed at the point of referral from a somatic to a psychiatric treatment setting. Analyses identified three main themes. Themes 1(Ascribing identity to the disorder) and 2 (Monocausal explanations) explore key elements of the participants' illness perceptions, and theme 3 (Mutable illness perceptions) explores how illness perceptions are influenced by experiences from healthcare encounters. The label 'functional disorder' was poorly integrated in the illness perceptions of the youths and their parents. Participants used a monocausal and typically physical explanation rather than a multicausal biopsychosocial explanation for their symptoms.