Ultrashort Stays and a Focus on Recovery
The three-phase treatment mode—assessment, implementation, and resolution—proposed by Dr. Glick and coauthors can address many of these issues, but I would like to highlight several that I feel are particularly important.
The role of the child psychiatrist should return to being that of a comprehensive deliverer and director of all aspects of treatment, so that coherent psychosocial diagnosis and individual, group, and family treatment can occur. This would be a time-intensive effort that could result in the development of child psychiatry hospitalists. In addition, treatment authorization must be based on psychosocial and diagnostic issues. Treatment goals for the child and family should be clarified at admission, a process that must include asking about perceptions of hospitalization, which may be based on films such as Sucker Punch or Girl, Interrupted. Also, viable individual safety plans (4) should be developed at admission for children who are prone to behavioral crises and harm to themselves or others.
Furthermore, admission screening questionnaires should be routinely used, including a children's depression inventory, a trauma assessment inventory, a substance abuse screen, and an incomplete-sentence form. Children may be willing to disclose their concerns on written forms rather than to an unknown professional. Screening for medical illnesses must also be routine and under the direction of a pediatrician who works closely with the child psychiatrist to identify chronic conditions, such as hepatitis, anemia, hyperglycemia, and obesity. In addition, a structured collaborative teaching and treatment environment should be created for the delivery of care. “A CBT Approach to Inpatient Psychiatric Hospitalization” (5) describes an effort developed to achieve these goals. Designed for stays of five to 12 days, the program is compatible with managed care treatment limits.
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5 : A CBT approach to inpatient psychiatric hospitalization. Journal of the American Academy of Child and Adolescent Psychiatry 44:708–711, 2005 Crossref, Medline, Google Scholar