The psychiatric hospitalization of children: An overview

Abstract

This paper reviews significant outcome studies regarding the hospitalization of latency-age children and examines pertinent admission criteria. Essential diagnostic and therapeutic components, including milieu therapy, individual therapy, family work, pharmacotherapy and school are discussed. The future role of psychiatric hospitalization of children is examined.

Adolescents’ Perspectives About Brief Psychiatric Hospitalization: What is Helpful and What is Not?

“…Based on a 2009 program census of patients in our age range (includes first time and repeat hospital users, so it is not a fully comparable population), the average age of study sample of 15.3 is similar to the overall adolescent inpatient population (15.6), yet our sample over-represents girls (61% in study vs. 56% overall) and non-whites (25% in study vs. 14% overall), and under-represents the population funded by Medicaid (19% in study vs. 37% overall). Most were hospitalized because of suicidal ideation or non-suicidal self harm (62.5% or 50), an additional 18.8% [15] actively attempted suicide, 12.5% [10] demonstrated aggression or out-of-control behavior (including substance use), and 6.3% [5] required treatment for medication assessment or school refusal. On average, participants were hospitalized for 7.6 days (SD = 3.9, range 3-31 days); for one of four adolescents, the hospitalization was planned ahead of time.…”

“…Over the past three decades, psychiatric inpatient treatment in public/community hospitals has changed dramatically, moving away from extensive, longterm therapy and a range of services, and toward brief treatment (typically 1 week) focusing on crisis stabilization, assessment, and discharge planning to facilitate access to outpatient treatment [2][3][4][5][6]. This trend is largely driven by motivation to reduce mental health care reimbursement rates [7], but also by values promoting the use of least restrictive treatment options, lest youth suffer negative psychosocial effects secondary to institutionalization and removal from one's community [8,9].…”

Separation Anxiety Disorder

“…Various commentators seem to concur about the circumstances that warrant hospitalization (Connell, 1985;Hersov & Bentovim, 1985;Dalton, Muller, & Forman, 1989). Connell's (1985) comprehensive criteria are (1) the need for diagnostic work that cannot be obtained on an outpatient basis; (2) severe problems that preclude parental management within the home (e.g., suicide attempts or severe aggression); (3) impaired physical status of the child that requires skilled nursing care (e. g., anorexia nervosa); (4) adverse environmental circumstances that preclude the child's improvement within the home; (5) gross overprotection by the parents or encouragement of infantilism after an injury; and (6) school refusal that cannot be managed on an outpatient basis (Dalton et al, 1989;Dalton & Forman, 1987). The overarching issue appears to be unequivocally establishing that hospitalization represents the most efficient and least invasive available therapeutic approach to remedying the clinical problems.…”

“…In addition to these four elements, the direct involvement of the parents throughout the course of the hospitalization of minors appears to be gaining some support in the psychiatric community (Dalton et al, 1989;Hersov & Bentovim, 1985). Although routine family services (e.g., a weekly or biweekly parent's group) may be insufficient to help families alter maladaptive interaction patterns that are unresponsive to prior outpatient intervention, psychologists may be able to take advantage of changing hospital policies to encourage parents' in-depth involvement in their child's treatment.…”

“…According to a review by Dalton et al (1989), corroborated by Hersov and Bentovim (1985), the following four components represent classic structural features of inpatient hospital settings for minors:…”