Evaluating effectiveness in adolescent mental health inpatient units: A systematic review

Abstract

Adolescent mental health research is a developing area. Inpatient units are the most widely used acute element of adolescent mental health services internationally. Little is known about inpatient units, particularly when it comes to measuring improvement for adolescents. Clinical outcome measurement in the broad context has gathered momentum in recent years, driven by the need to assess services. The measurement of outcomes for adolescents who access inpatient care is critical, as they are particularly vulnerable and are often considered the most difficult to treat. Following the PRISMA guidelines, the aim of this review was to assess whether adolescent inpatient units are effective and understand how outcomes are measured. CINAHL, MEDLINE with Full Text, ERIC, PsycINFO, and Cochrane databases were systematically searched. Studies were included if the inpatient units were generic and adolescents were between the mean age of 12-25 years. Furthermore, studies published in English within the last ten years were included. Exclusions were outpatient and disorder-specific inpatient settings. A total of 16 studies were identified. Each study demonstrated effectiveness on at least one outcome measure in terms of symptom stabilization. However, several outcome measures were used and therefore inpatient units lack consistency in how they measure improvement. Inpatient units are effective for the majority of young people as they result in symptom stabilization. Whilst symptom stabilization can be achieved, future research examining the mechanism of change is needed.

The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care

“…Of the dearth of studies examining adolescent inpatient units, most have used quantitative methods of inquiry (Hayes et al, ; Indig et al, ; Lee, Martin, Hembry, & Lewis, ; Patterson et al, ; Rouski, Hodge, & Tatum, ; Seckman et al, ). Whilst this approach might be appropriate for some effectiveness and outcome studies, there are limitations when attempting to understand a specialized inpatient service.…”

Nursing in child psychiatric milieus: What nurses do: An update

“…Finally, research is needed on how adolescents use the hospitalization event to build a positive perception of self, and how nurses use the relationship to help them begin this process. While this change in self or self‐perception is logically connected to a nursing relationship‐based focus (Geanellos, ), there is a paucity of youth inpatient outcomes studies and those that are published vary widely in quality and the measures used (Biering, ; Hayes, Simmons, Simons, & Hopwood, ). Moreover, the standardized survey‐type satisfaction instruments that are now available (Toomey et al., ) may not fit well with what children/adolescents and their families seek and how they frame improvement (Salamone‐Violi et al., 2015).…”

What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review

“…This was observed in a recent systematic review, which examined the effectiveness of adolescent inpatient units and adolescent outcomes (Hayes et al . ). The review found that several studies failed to report on important features of each inpatient unit, such as what nonpharmacological therapeutic interventions were delivered.…”

“…Inpatient units are known to be effective for the majority of adolescents in that they improve in at least one area of their symptomatology from admission to discharge (Bettmann & Jasperson 2009;Hayes et al 2018). Inpatient units play an important role in meeting the complex needs of adolescents within the continuum of care.…”